不同时机局部神经阻滞在开腹肝切除中的镇痛效果比较  

Comparison of analgesic effects of regional nerve blocks at different time points in open hepatectomy

作　　者：张婵 吕瑶 张小燕 张鸣青[1] Chan Zhang;Yao Lyu;Xiaoyan Zhang;Mingqing Zhang(Department of Gastroenterology,the No.909 Hospital(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,China;Department of Anesthesiology,the No.909 Hospital(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)消化内科,福建省漳州市363000 [2]第九〇九医院(厦门大学附属东南医院)麻醉科,福建省漳州市363000

出　　处：《中华肝脏外科手术学电子杂志》2024年第2期189-194,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：福建省自然科学基金(2021J01545)。

摘　　要：目的:探讨不同时机腹横肌平面阻滞在开腹肝切除患者中的镇痛效果。方法:回顾性分析2020年1月至2021年12月第九〇九医院行开腹肝切除的117例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男75例,女42例;年龄37~59岁,中位年龄50岁。根据腹横肌平面阻滞时机分为术前组(56例)和术后组(61例)。对比两组阻滞持续时间,24 h舒芬太尼用量,术后第12、24 h视觉模拟评分(VAS)和舒适度评分(BCS),TNF-α、IL-1、皮质醇(Cor)、促肾上腺皮质激素(ACTH)及不良反应发生等。两组围手术期指标比较采用t检验,不良反应比较采用χ2检验。结果:术前组阻滞持续时间平均为(12.6±2.2)h,明显短于术后组的(14.9±3.1)h(t=-5.945,P<0.05);术前组术后24 h舒芬太尼按压次数为(5.7±1.5)次,明显高于术后组的(4.4±1.3)次(t=5.243,P<0.05)。术前组术后12、24 h的VAS分别为(3.6±0.9)、(3.8±0.9)分,明显高于术后组的(3.0±0.8)、(3.1±0.6)分(t=4.074,4.654;P<0.05)。术前组术后12、24 h的BCS分别为(1.6±0.8)、(1.5±0.8)分,明显低于术后组(2.0±0.8)、(1.9±0.8)分(t=-2.763,-3.048;P<0.05)。术前组术后1 d的TNF-α、IL-1、Cor、ACTH分别为(5.4±1.4)μg/L、(77±14)ng/L、(246±22)mmol/L、(75±9)ng/L,明显高于术后组的(4.2±1.5)μg/L、(54±11)ng/L、(217±20)mmol/L、(60±10)ng/L(t=4.491,8.770,9.509,10.260;P<0.05)。两组头痛头晕、恶心呕吐、皮肤瘙痒分别为2、2、1例和3、2、2例,不良反应发生率差异无统计学意义(P>0.05)。结论:术后行腹横肌平面阻滞可延长神经阻滞时间,提高患者舒适度,改善镇痛效果,可能与降低炎症因子和应激激素水平有关,同时不会延缓术后康复和增加不良反应发生率,是一种可供选择的围手术期镇痛方案。Objective To evaluate the analgesic effects of transverse abdominis plane blocks at different time points in patients undergoing open hepatectomy.Methods Clinical data of 117 patients who underwent open hepatectomy in the No.909 Hospital from January 2020 to December 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,75 patients were male and 42 female,aged from 37 to 59 years,with a median age of 50 years.According to the time points of transverse abdominis plane blocks,all patients were divided into the preoperative(n=56)and postoperative groups(n=61).The duration of block,sufentanil dosage at 24 h,visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)scores at postoperative 12 and 24 h,TNF-α,IL-1,cortisol(Cor),adrenocorticotropic hormone(ACTH)and the incidence of adverse reactions were statistically compared between two groups.Perioperative indexes were compared by t test,and the incidence of adverse reactions was compared by Chi-square test.Results In the preoperative group,the average duration of transverse abdominis plane block was(12.6±2.2)h,significantly shorter than(14.9±3.1)hin the postoperative group(t=-5.945,P<0.05).In the preoperative group,the number of patient-controlled analgesia(PCIA)compressions at postoperative 24 h was(5.7±1.5)times,which was significantly higher than(4.4±1.3)times in the postoperative group(t=5.243,P<0.05).In the preoperative group,the VAS scores at postoperative 12 and 24 h were 3.6±0.9 and 3.8±0.9,significantly higher than 3.0±0.8 and 3.1±0.6 in the postoperative group(t=4.074,4.654;P<0.05).In the preoperative group,the BCS at postoperative 12 and 24 h was 1.6±0.8 and 1.5±0.8,significantly lower than 2.0±0.8 and 1.9±0.8 in the postoperative group(t=-2.763,-3.048;P<0.05).In the preoperative group,TNF-α,IL-1,Cor and ACTH levels at postoperative1 d were(5.4±1.4)μg/L,(77±14)ng/L,(246±22)mmol/L and(75±9)ng/L,significantly higher than(4.2±1.5)μg/L,(54±11

关 键 词：肝切除术 肝肿瘤 镇痛 加速康复 腹横肌平面阻滞 应激 炎症因子 

分 类 号：R614[医药卫生—麻醉学]