摘要 目的：观察不同麻醉方式对胃肠道手术的镇痛效果及安全性。方法：将90例胃肠道手术患者纳入研究，数字随机法分为静脉全麻复合TAP阻滞组（TAP组）、静脉全麻复合硬膜外麻醉组（CEA组）及静脉全麻复合局部麻醉组（AP组），每组各30例。比较三组患者术中生命体征变化、麻醉效果、术中补液量、血管活性药使用率，术后不同时间点VAS评分，术后第1次补救性镇痛药物使用时间、下床时间、尿管拔除时间、术后首次肠道排气时间、住院时间的差异，同时记录不良反应发生情况。结果：（1）TAP和AP患者术中不同时间点的SBP、DBP、HR、SPO2差异无统计学意义（P>0.05）。CEA组T1、T2、T3三个时间点SBP、DBP、HR均低于T0，且低于同时间点的TAP组及AP组，差异有统计学意义（P＜0.05），CEA组T4 SBP、DBP、HR逐渐升高，T5时间点SBP、DBP、HR高于T1，差异有统计学意义（P＜0.05），TAP与AP组具有相同的趋势。（2）三组麻醉操作时间，TAP和CEA无统计学差异，AP组时间短于其余两组，差异有统计学差异（P<0.05）；TAP组和AP术中出血量、术中补液量少于CEA组，差异有统计学意义（P<0.05），CEA术中去甲肾上腺素使用量较TAP组及AP组增加，差异有统计学意义（P<0.05）。（3）术后不同时间点TAP组和CEA组VAS评分差异无统计学意义（P>0.05），AP组术后1h、4h、8h、12 h、24h 时间点VAS评分均高于TAP组和CEA组，差异有统计学意义（P<0.05），术后48h三组VAS 评分差异无统计学意义（P>0.05）；（4）TAP组及AP组下床时间、尿管拔除时间、术后首次肠道排气时间均明显短于CEA组，差异有统计学意义（P<0.05），TAP和AP组差异无统计学意义（P>0.05），AP组舒芬太尼使用量及镇痛泵次数较TAP组及CEA组增多，差异有统计学意义（P<0.05），TAP和CEA组舒芬太尼使用量及镇痛泵次数差异无统计学意义（P>0.05）。（5）TAP组不良反应发生率低于CEA组及AP组，差异有统计学意义（P<0.05）。结论：超声引导下TAP阻滞可为胃肠道手术患者提供理想的镇痛效果，手术安全，术后不良反应少，临床可推广应用。

Objective: To observe the analgesic effect and safety of different anesthesia methods on gastrointestinal surgery. Methods: 90 cases of gastrointestinal surgery were included in the study. They were randomly divided into intravenous general anesthesia combined with tap block (tap group), intravenous general anesthesia combined with epidural anesthesia (CEA) and intravenous general anesthesia combined with local anesthesia (AP group), with 30 cases in each group. The changes of vital signs, anesthetic effect, intraoperative rehydration volume, the use rate of vasoactive drugs, the changes of vas at different time points after operation, the time of the first postoperative remedial analgesia, the time of getting out of bed, the time of urinary catheter extraction, the time of the first postoperative intestinal exhaust and the time of hospitalization were compared, and the occurrence of adverse reactions were recorded. Results: (1) there was no significant difference in SBP, DBP, HR and SpO2 between tap and AP patients at different time points (P > 0.05). SBP, DBP and HR in CEA group at T1, T2 and T3 time points were lower than T0, and lower than tap group and AP group at the same time point, the difference was statistically significant (P < 0.05). T4 SBP, DBP and HR in CEA group gradually increased, and SBP, DBP and HR at T5 time point were higher than T1, the difference was statistically significant (P < 0.05). Tap and AP group had the same trend. (2) There was no significant difference in anesthesia operation time, tap and CEA among the three groups, but the time in AP group was shorter than that in the other two groups (P < 0.05). There was no significant difference in anesthesia operation time, tap and CEA in t three groups, but the time in AP group was shorter than that in the other two groups (P < 0.05); The amount of intraoperative bleeding and intraoperative rehydration in tap group and AP group were less than that in CEA group, the difference was statistically significant (P < 0.05). The amount of norepinephrine used in CEA group was significantly higher than that in tap group and AP group (P < 0.05). (3) There was no significant difference in VAS scores between tap group and CEA group at different time points after operation (P > 0.05). VAS scores at 1H, 4h, 8h, 12h and 24h in AP group were higher than those in tap group and CEA group (P < 0.05). There was no significant difference in VAS scores at 48h after operation (P > 0.05); (4) The time of getting out of bed, the time of catheter extraction and the first postoperative intestinal exhaust in tap group and AP group were significantly shorter than those in CEA group (P < 0.05), but there was no significant difference between tap group and AP group (P > 0.05). The dosage of sufentanil and the number of analgesic pumps in AP group were significantly higher than those in tap group and CEA group (P < 0.05), but there was no significant difference in the dosage of sufentanil and the number of analgesic pumps between tap and CEA group (P > 0.05). (5) The incidence of adverse reactions in tap group was significantly lower than that in CEA group and AP group (P < 0.05). Conclusion: Ultrasound-guided tap block can provide ideal analgesic effect for patients undergoing gastrointestinal surgery, with safe operation and less postoperative adverse reactions. It can be popularized in clinic