SAPB复合RSB对肝癌切除术病人苏醒及镇痛影响  

Effect of serratus anterior plane block combined with rectus sheath block on recovery of consciousness and analgesia in patients under-going hepatectomy for primary liver cancer

作　　者：王洪涛 王振云 周瑞欣 张津广 庞玉池 WANG Hongtao;WANG Zhenyun;ZHOU Ruixin;ZHANG Jinguang;PANG Yuchi(Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院麻醉科,河北沧州061000

出　　处：《青岛大学学报(医学版)》2025年第1期95-99,共5页Journal of Qingdao University(Medical Sciences)

基　　金：河北省医学科学研究课题计划项目(20241255)。

摘　　要：目的分析前锯肌平面阻滞(SAPB)复合腹直肌鞘阻滞(RSB)对原发性肝癌(肝癌)切除术病人苏醒质量及镇痛效果的影响。方法2021年2月—2023年2月,选择河北省沧州中西医结合医院住院手术治疗的肝癌病人86例为研究对象,采用简单随机的方法分为研究组42例和对照组44例。两组病人均行全身麻醉,对照组实施常规静脉镇痛,研究组给予SAPB复合RSB。比较两组手术前后心率(HR)、平均动脉压(MAP)、小波指数(WLi)、焦虑指数(ANXi)和舒适指数(CFi),术后2、6、12和24 h的疼痛视觉模拟量表(VAS)评分,疼痛递质神经肽Y(NPY)、P物质(SP)、去甲肾上腺素(NE)等指标,以及术后不良反应发生率。结果与对照组相比较,研究组术后HR和MAP波动显著减小(t=12.725、20.308,P均<0.05),WLi、ANXi和CFi变化范围明显缩小(t=18.616~22.520,P均<0.05);研究组术后2、6、12和24 h的VAS评分均显著低于对照组(F=33.275~45.434,P均<0.05),NPY、SP和NE水平均明显低于对照组(F=13.970~106.881,P均<0.05)。对照组术后不良反应发生率为20.4%,明显高于研究组的4.8%(χ^(2)=4.744,P<0.05)。结论SAPB复合RSB能有效提高肝癌切除术病人的苏醒质量和镇痛效果,降低术后不良反应发生率,值得临床推广应用。Objective To investigate the effect of serratus anterior plane block(SAPB)combined with rectus sheath block(RSB)on recovery of consciousness and analgesia in patients undergoing hepatectomy for primary liver cancer.Methods A total of 86 patients with liver cancer who were admitted to Cangzhou Integrated Traditional Chinese and Western Medical Hospital and underwent surgical treatment from February 2021 to February 2023 were enrolled as subjects,and they were divided into study group with 42 patients and control group with 44 patients using the simple randomization method.General anesthesia was performed for both groups,and the patients in the control group received conventional intravenous analgesia,while those in the study group received SAPB combined with RSB.The two groups were compared in terms of heart rate(HR),mean arterial pressure(MAP),wavelet index(WLi),anxiety index(ANXi),comfort index(CFi),Visual Analogue Scale(VAS)score at 2,6,12,and 24 h after surgery,neuropeptide Y(NPY),substance P(SP),norepinephrine(NE),and the incidence rate of postoperative adverse reactions.Results Compared with the control group,the study group had significant reductions in the fluctuations of HR and MAP(t=12.725,20.308,P<0.05)and the ranges of changes in WLi,ANXi,and CFi after surgery(t=18.616-22.520,P<0.05).Compared with the control group,the study group had significantly lower VAS scores at 2,6,12,and 24 h after surgery(F=33.275-45.434,P<0.05)and significantly lower levels of NPY,SP,and NE(F=13.970-106.881,P<0.05).The control group had a significantly higher incidence rate of postoperative adverse reactions than the study group(20.4%vs 4.8%,χ^(2)=4.744,P<0.05).Conclusion SAPB combined with RSB can effectively improve the quality of recovery of consciousness and analgesia in patients undergoing hepatectomy for liver cancer and reduce the incidence rate of postoperative adverse reactions,and therefore,it holds promise for clinical application.

关 键 词：神经传导阻滞 前锯肌平面阻滞 腹直肌鞘阻滞 癌 肝细胞 外科手术 苏醒谵妄 疼痛测定 

分 类 号：R614.4[医药卫生—麻醉学] R730.261[医药卫生—外科学]