罗哌卡因切口局部浸润麻醉对开腹肝癌肝切除术后患者麻醉复苏期镇痛效果的影响  

Impact of local incision infiltrated anesthesia with ropivacaine on analgesia efficacy during anesthesia recovery period in liver cancer patients following open hepatectomy

作　　者：张韵希 黄冬琴 邹龙涛[1] 黄英明[1] 覃韬[1] 黎阳[1] 黄冰[1] ZHANG Yun-xi;HUANG Dong-qin;ZOU Long-tao;HUANG Ying-ming;QIN Tao;LI Yang;HUANG Bing(Department of Anesthesiology,Guangxi Medical University Affiliated Tumor Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院麻醉科,南宁市530021

出　　处：《广西医学》2021年第3期275-279,共5页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z20191050)。

摘　　要：目的探讨罗哌卡因切口局部浸润麻醉对开腹肝癌肝切除术后患者麻醉复苏期镇痛效果的影响。方法将择期行开腹肝癌肝部分切除术的60例患者随机分为L1组、L2组与C组,每组20例。L1和L2组患者术后均采用多模式镇痛(罗哌卡因切口局部镇痛+静脉自控镇痛),L1组患者在手术开始前给予0.25%罗哌卡因切口局部浸润麻醉,L2组患者则在缝合皮肤前给予0.25%罗哌卡因切口局部浸润麻醉,C组不给予手术切口局部浸润麻醉,仅行术后静脉自控镇痛。记录3组患者麻醉诱导前(T_(1))、切皮时(T_(2))、切皮后30 min(T_(3))、切肝时(T_(4))、缝皮结束时(T_(5))、拔管前(T_(6))、术后2 h(T_(7))、术后3 h(T_(8))、术后4 h(T_(9))的平均动脉压(MAP),以及T_(1)、T_(3)、T_(5)时的血糖水平;记录麻醉苏醒期(T_(6)、T_(7)、T_(8)、T_(9))3组患者安静时与咳嗽时的疼痛视觉模拟量表(VAS)评分;比较3组患者手术过程中丙泊酚和瑞芬太尼的使用剂量,以及麻醉药物相关不良反应发生率。结果T_(2)、T_(3)时L1组患者的MAP均低于C组,T_(5)、T_(6)时L1组与L2组的MAP均低于C组(均P<0.05);而其他时间点3组患者的MAP差异均无统计学意义(均P>0.05)。T_(3)时L1组的血糖水平均低于L2组和C组(均P<0.05),而其他时间点3组患者的血糖水平差异均无统计学意义(均P>0.05)。T_(6)时L1组与L2组的安静VAS评分及咳嗽VAS评分均低于C组(均P<0.05),T_(7)、T_(8)时L2组的咳嗽VAS评分均低于C组(均P<0.05);而在其他时间点,3组患者的安静VAS评分及咳嗽VAS评分差异均无统计学意义(均P>0.05)。3组患者丙泊酚和瑞芬太尼的使用量比较,差异均无统计学意义(均P>0.05)。所有患者术后均未出现呼吸系统和循环系统抑制表现,且3组患者头晕、烦躁不安、恶心呕吐、皮肤瘙痒的发生率比较,差异均无统计学意义(均P>0.05)。结论在多模式镇痛的基础上,给予0.25%罗哌卡因切口局部浸润麻醉可有效�Objective To investigate the impact of local incision infiltrated anesthesia with ropivacaine on analgesia efficacy during anesthesia recovery period in liver cancer patients following open hepatectomy.Methods Sixty patients scheduled for partial hepatectomy for liver cancer were randomly divided into group L1,group L2 and group C,with 20 cases in each group.Patients in groups L1 and L2 were treated with postoperative multimodal analgesia(local incision analgesia with ropivacaine plus patient-controlled intravenous analgesia[PCIA]),patients in group L1 were given local incision infiltrated anesthesia with 0.25%ropivacaine before surgery,patients in group L2 were given local incision infiltrated anesthesia with 0.25%ropivacaine before skin suture,group C did not receive local incision infiltrated anesthesia but only received postoperative PCIA.Mean arterial pressure(MAP)before anesthesia induction(T_(1)),at the time of skin incision(T_(2)),30 minutes after skin incision(T_(3)),at the time of liver resection(T_(4)),at the end of skin suture(T_(5)),before extubation(T_(6)),two(T_(7)),three(T_(8))and four hours after operation(T_(9)),and blood glucose levels at T_(1),T_(3) and T_(5) were recorded in the three groups;the Visual Analogue Scale(VAS)pain scores at rest and during cough were recorded during anesthesia recovery period(T_(6),T_(7),T_(8) and T_(9)),and the dosages of propofol and remifentanil during operation,as well as the incidence rate of adverse reactions related to anesthetics were compared among the three groups.Results Group L1 had lower MAP at T_(2) and T_(3),and group L1 and group L2 had lower MAP at T_(5) and T_(6) than group C(all P<0.05);moreover,there was no statistically significant difference in MAP among the three groups at other time points(all P>0.05).Group L1 reported a lower blood glucose level at T_(3) than group L2 or C(all P<0.05),whereas there was no statistically significant difference in blood glucose level among the three groups at other time points(all P>0.05).At T_(6),VAS score a

关 键 词：罗哌卡因 局部浸润麻醉 右美托咪定 多模式镇痛 麻醉复苏期 开腹 肝癌 肝切除术 

分 类 号：R614.32[医药卫生—麻醉学]