全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究  

Application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone removal

作　　者：韩洋[1] 张莉莉[1] 王雨峰 贾倩倩[1] Han Yang;Zhang Lili;Wang Yufeng(Department of Anesthesiology,First Hospital,Qinhuangdao 066000,Hebei Province,China)

机构地区：[1]河北省秦皇岛市第一医院麻醉科,066000 [2]河北医科大学第三附属医院麻醉科

出　　处：《实用肝脏病杂志》2024年第6期943-946,共4页Journal of Practical Hepatology

基　　金：河北省秦皇岛市科学技术研究与发展计划项目(编号:202301A269)。

摘　　要：目的探讨采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处理外科手术治疗的肝内胆管结石(IHS)患者术后镇痛效果。方法2020年4月~2024年1月我院收治的60例IHS患者,均接受外科手术切除含有结石的肝组织。在麻醉镇痛时,将患者分成两组,其中在28例对照组采用胸椎旁神经阻滞,在32例观察组采用前锯肌平面阻滞和腹直肌后鞘阻滞,比较两组包括麻醉恢复室(PACU)停留时间等手术指标,采用Ramsay镇静评分及静息和活动时视觉模拟评分(VAS),采用术后恢复质量量表(QoR-40)评估恢复质量。结果观察组PACU停留时间为(35.1±2.0)min,显著短于对照组【(40.3±2.1)min,P<0.05】;在术后2 h和24 h时,观察组静息VAS评分分别为(2.9±1.4)分和(2.5±1.1)分,显著低于对照组【分别为(3.7±1.7)分和(3.3±1.4)分,P<0.05】,活动VAS评分分别为(3.7±1.6)分和(2.9±1.5)分,显著低于对照组【分别为(4.4±1.5)分和(3.6±1.4)分,P<0.05】;观察组疼痛感受、身体舒适度和QoR-40总分分别为(35.3±1.2)分、(52.8±2.3)分和(175.0±8.0)分,均显著高于对照组【分别为(28.4±1.5)分、(45.8±2.8)分和(165.1±9.7)分,P<0.05】。结论在行外科手术切除HIS患者肝内结石时,采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞的镇痛效果比较好,可以提高患者舒适度。Objective The aim of this study was to investigate application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone(IHS)removal.Methods 60 patients with HIS were encountered in our hospital between April 2020 and January 2024,and all underwent surgery operation for removal of the stones under general anesthesia.For analgesia,patients were divided into control(n=28),receiving thoracic paravertebral nerve block,and observation(n=32),receiving serratus anterior plane block and posterior rectus sheath block.Post-anesthesia care unit(PACU)stay and other operation parameters were recorded,Ramsay sedation scores,resting and motion visual analogue scale(VAS)scores,and quality of recovery-40 questionnaire(QoR-40)were assessed.Results PACU stay in the observation was(35.1±2.0)min,much shorter than[(40.3±2.1)min,P<0.05]in the control;by 2 and 24 hours after operation,resting VAS scores in the observation were(2.9±1.4)points and(2.5±1.1)points,both significantly lower than[(3.7±1.7)points and(3.3±1.4)points,respectively,P<0.05],and motion VAS scores were(3.7±1.6)points and(2.9±1.5)points,both significantly lower than[(4.4±1.5)points and(3.6±1.4)points,P<0.05]in the control;pain perception,physical comfort and postoperative QoR-40 score in the observation were(35.3±1.2)points,(52.8±2.3)points and(175.0±8.0)points,all significantly higher than[(28.4±1.5)points,(45.8±2.8)points and(165.1±9.7)points,respectively,P<0.05]in the control.Conclusion In patients with HIS undergoing surgery operation for removal of stones under general anesthesia,serratus anterior plane block and posterior rectus sheath block have a satisfactory analgesic effects,and improve quality of recovery.

关 键 词：肝内胆管结石 前锯肌平面阻滞 腹直肌后鞘阻滞 全身麻醉 镇痛 

分 类 号：R614[医药卫生—麻醉学]