前锯肌平面复合腹直肌鞘阻滞在开腹肝癌切除术中的镇痛效果  

Analgesic effect of serratus anterior plane combined with rectus sheath block in open hepatocellular carcinoma resection

作　　者：蔡宇平 陈育人[1] 陈晓[1] 许德明[1] 林新强 CAI Yuping;CHEN Yuren;CHEN Xiao;XU Deming;LIN Xinqiang(Department of Anesthesiology,Affiliated Hospital of Putian University,Fujian Province,Putian351100,China)

机构地区：[1]莆田学院附属医院麻醉科,福建莆田351100

出　　处：《中国当代医药》2022年第19期5-9,共5页China Modern Medicine

基　　金：福建省海峡医药卫生交流协会舒适化医疗科研项目(2020-HYH-04)。

摘　　要：目的探讨前锯肌平面复合腹直肌鞘阻滞在开腹肝癌切除术中的镇痛效果。方法选取2019年10月至2021年5月莆田学院附属医院收治的60例肝癌患者作为研究对象,按照随机数字表法分为S组(n=30)与C组(n=30)。S组采用前锯肌平面复合腹直肌鞘神经阻滞联合全身麻醉方法,C组采用单纯全身麻醉方法。比较两组切皮前(T_(1)),切皮后5、30、60 min(T_(2)~T_(4)),术毕(T_(5))的平均动脉压(MAP)、心率(HR)、手术体积描计指数(SPI);比较两组术后2、6、12、24 h静息、咳嗽时的视觉模拟评分法(VAS)评分;比较两组术中瑞芬太尼的总用量,术后12、24 h内静脉自控镇痛(PCIA)按压次数及术后不良反应发生情况。结果两组患者T_(1)、T_(5)时MAP、HR、SPI比较,差异无统计学意义(P>0.05)。两组T_(2)~T_(5)时的HR、MAP、SPI均高于T_(1),差异有统计学意义(P<0.05)。S组T_(2)~T_(4)的HR、MAP、SPI低于C组,差异有统计学意义(P<0.05)。静息状态下,S组术后6、12 h的VAS评分低于C组,差异有统计学意义(P<0.05)。咳嗽状态下,S组术后6、12、24 h的VAS评分低于C组,差异有统计学意义(P<0.05)。S组术中瑞芬太尼用量及术后12、24 h的PCIA按压次数少于C组,差异有统计学意义(P<0.05)。S组的不良反应总发生率低于C组,差异有统计学意义(P<0.05)。结论前锯肌平面复合腹直肌鞘神经阻滞可为开腹肝癌切除术有效减少手术应激及术中阿片类药物使用,稳定血流动力学,提供良好的术后镇痛,降低并发症发生率,促进患者快速康复,值得临床上应用。Objective To study the analgesic effect of serratus anterior plane block combined rectus sheath block in patients undergoing radical operation of hepatic carcinoma.Methods A total of 60 liver cancer patients admitted to Affiliated Hospital of Putian University from October 2019 to May 2021 were selected as the research subjects,and they were divided into group S(n=30)and group C(n=30)according to random number table method.Group S was treated with serratus anterior muscle plane combined with rectus sheath nerve block combined with general anesthesia,while group C was treated with general anesthesia alone.Mean arterial pressure(MAP),heart rate(HR)and surgical volume index(SPI)were compared between the two groups before(T_(1)),5,30 and 60 min after(T_(2)-T_(4))and after(T_(5)).Visual analogue scale(VAS)scores at rest and cough were compared between the two groups at 2,6,12 and 24 h postoperatively.The total amount of remifentanil,the pressing times of intravenous controlled analgesia(PCIA)within 12 and 24 h after operation and the incidence of postoperative adverse reactions were compared between the two groups.Results There were no significant differences in MAP,HR and SPI between two groups at T_(1),T_(5)(P>0.05).HR,MAP and SPI at T_(2)-T_(5) were higher than those at T_(1),the differences were statistically significant(P<0.05).HR,MAP and SPI of T_(2)-T_(4) in group S were lower than those in group C,and the differences were statistically significant(P<0.05).In the resting state,the VAS score of group S was lower than that of group C at 6 and 12 h after surgery,the difference was statistically significant(P<0.05).Under cough condition,VAS score of group S was lower than that of group C at 6,12 and 24 h after operation,with statistical significance(P<0.05).The amount of Remifentanil in group S and the times of PCIA pressing 12 and 24 h after operation were less than those in group C,the differences were statistically significant(P<0.05).The total incidence of adverse reaction in group S was lower than that in grou

关 键 词：超声引导 前锯肌平面阻滞 腹直肌鞘神经阻滞 开腹肝癌切除术 围手术期镇痛 手术体积描计指数 

分 类 号：R614.2[医药卫生—麻醉学]