肝内胆管结石患者接受腹腔镜下肝叶切除术竖脊肌平面阻滞与腹横肌平面阻滞镇痛效果对比研究  

Comparative study on post-operational analgesia by erector spinae plane block or by transversus abdominis plane block in patients with intrahepatic lithiasis undergoing laparoscopic hepatic lobectomy

作　　者：冯梁 林静[2] 高敏 雷宇[1] Feng Liang;Lin Jing;Gao Min(Department of Anesthesiology,Central Hospital,Guangyuan 628000,Sichuan Province,China)

机构地区：[1]四川省广元市中心医院麻醉科,628000 [2]川北医学院附属医院麻醉科

出　　处：《实用肝脏病杂志》2024年第5期789-792,共4页Journal of Practical Hepatology

基　　金：2020年四川省卫健委青年医学创新研究项目(编号:Q20051)。

摘　　要：目的探讨肝内胆管结石患者接受腹腔镜下肝叶切除术时竖脊肌平面阻滞(ESPB)与腹横肌平面阻滞(TAPB)的镇痛效果。方法2021年10月~2023年10月我院诊治的肝内胆管结石患者94例,均接受腹腔镜下肝叶切除术治疗。在麻醉前,随机将患者分为观察组47例和对照组47例,分别在超声引导下行ESPB或TAPB麻醉镇痛。采用疼痛视觉模拟评分(VAS)和Ramsay镇静评分量表评估镇痛和镇静效果。采用ELISA法检测血清皮质醇(Cor)、去甲肾上腺素(Ne)和肾上腺素(E)水平。结果在术后6 h、12 h和24h,观察组动态VAS评分分别为(3.1±0.6)分、(3.3±0.7)分和(3.2±0.6)分,显著低于对照组【分别为(3.8±0.7)分、(4.1±0.7)分和(3.9±0.8)分,P<0.05】;在术后48h,观察组血清Cor、Ne和E水平分别为(264.2±29.7)pg/ml、(2.8±0.6)pg/ml和(203.9±26.8)pg/ml,均显著低于对照组【分别为(306.3±33.2)pg/ml、(3.5±0.8)pg/ml和(257.8±32.3)pg/ml,P<0.05】;在术后48h,观察组镇痛泵按压(4.8±1.3)次,显著少于对照组【(6.1±1.8)次,P<0.05】;术后,观察组不良反应发生率为14.9%,与对照组的17.0%比较,差异无统计学意义(P>0.05)。结论在行腹腔镜下肝叶切除术治疗的肝内胆管结石患者,采用超声引导下ESPB较TAPB可获得更好的术后镇痛效果,或与有效减轻应激反应有关。Objective The aim of this study was to compare post-operational analgesia by erector spinae plane block(ESPB)or by transversus abdominis plane block(TAPB)in patients with intrahepatic lithiasis undergoing laparoscopic hepatic lobectomy.Methods 94 patients with intrahepatic bile duct stones were enrolled in our hospital between October 2021 and October 2023,and all patients underwent laparoscopic hepatic lobectomy.For post-operational analgesia,47 patients were assigned to receive ESPB under ultrasound(US)guidance and another 47 patients to receive TAPB under US guidance.Visual analogue scale(VAS)and Ramsay sedation score scale were applied to assess the postoperative analgesia and sedation.Serum cortsisol(Cor),norepinephrine(Ne)and epinephrine(E)levels were detected by ELISA.Results At 6 hours,12 hours and 24 hours after surgery,VAS scores in patients receiving ESPB were(3.1±0.6)points,(3.3±0.7)points and(3.2±0.6)points,all significantly lower than[(3.8±0.7)points,(4.1±0.7)points and(3.9±0.8)points,P<0.05]in patients receiving TAPB;at 48hours after operation,serum Cor,Ne and E levels were(264.2±29.7)pg/ml,(2.8±0.6)pg/ml and(203.9±26.8)pg/ml,all significantly lower than[(306.3±33.2)pg/ml,(3.5±0.8)pg/ml and(257.8±32.3)pg/ml,respectively,P<0.05]in those receiving TAPB;analgesic pump compressions was(4.8±1.3)times,much less than[(6.1±1.8)times,P<0.05]in patients receiving TAPB;incidence of adverse events were 14.9%vs.17.0%,not statistically different between the two groups(P>0.05).ConclusionIn patients with intrahepatic lithiasis undergoing laparoscopic hepatic lobectomy,ultrasound-guided ESPB could achieve a satisfactory analgesia post-operationally,which might relieve bodystress reactions.

关 键 词：肝内胆管结石 腹腔镜下肝叶切除术 超声引导 竖脊肌平面阻滞 腹横肌平面阻滞 镇痛 

分 类 号：R614[医药卫生—麻醉学]