椎旁神经阻滞复合全身麻醉对腹腔镜下肝切除术后肝损伤的保护作用  

Protective effect of paravertebral nerve block combined with general anesthesia on postoperative liver injury in patients undergoing laparoscopic hepatectomy

作　　者：宋雨汐 徐小 高宪 段家翔 文静 甯交琳 SONG Yuxi;XU Xiao;GAO Xian;DUAN Jiaxiang;WEN Jing;NING Jiaolin(Department of Anesthesiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆

出　　处：《陆军军医大学学报》2025年第7期720-727,共8页Journal of Army Medical University

基　　金：陆军军医大学优秀人才库重点扶持对象个性化培养方案。

摘　　要：目的探究椎旁神经阻滞复合全身麻醉对腹腔镜下肝切除(laparoscopic hepatectomy,LH)术后肝损伤的保护作用。方法本研究为随机对照研究,纳入2024年4-8月陆军军医大学第一附属医院肝胆外科收治的51例接受LH的患者作为研究对象,采用随机数表法将入组患者随机分为对照组(n=25)和椎旁阻滞组(n=26)。对照组采用全身麻醉,椎旁阻滞组在全麻诱导前进行椎旁神经阻滞,其余医疗处置相同。比较2组患者:术前7 d内、术后第1、2天谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、胆红素(total bilirubin,TBIL)、白蛋白(albumin,ALB)、全身免疫炎症指数(systemic-immune inflammation index,SII)水平,麻醉诱导前(T1)、建立气腹前5 min(T2)、建立气腹时(T3)、第1次肝门阻断时(T4)心率和平均动脉压(mean arterial pressure,MAP),术中去甲肾上腺素、七氟烷、术后24 h镇痛药物使用量以及2组患者手术时间、拔管时间、麻醉复苏室(postanesthesia care unit,PACU)停留时间、住院时间。结果椎旁阻滞组患者术后第1天ALT[178.40(126.55,325.86)vs 292.20(197.20,468.95)U/L]、术后第2天SII[704.13(486.61,1078.59)vs 1075.09(753.80,1614.38)]、术后24 h镇痛药使用量[29.70(27.37,32.07)vs 31.99(28.92,40.81)mg]均较对照组降低(P<0.05);椎旁阻滞组T3、T4时MAP、拔管时间、PACU停留时间及住院时间均较对照组显著下降(P<0.05)。结论椎旁神经阻滞复合全身麻醉可在一定程度上减轻患者LH术后炎症反应和疼痛,维持血流动力学稳定,进而保护肝损伤。Objective To investigate the protective effect of paravertebral nerve block combined with general anesthesia on liver injury after laparoscopic hepatectomy(LH).Methods A randomized controlled trial was conducted on 51 patients undergoing LH in our hospital between April and August 2024.They were randomly divided into control group(n=25,general anesthesia)and paravertebral block group(n=26,paravertebral nerve block before general anesthesia induction).Beside anesthesia,they received same other medical treatment.The following indicators were compared between the 2 groups,that is,serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and albumin(ALB),and systemic-immune inflammation(SII)index within 7 d before and on the 1st and 2nd days after surgery;heart rate and mean arterial pressure(MAP)before anesthesia induction(T1),before pneumoperitoneum establishment(T2),pneumoperitoneum establishment(T3),and at the first hilar occlusion(T4);usages of intraoperative norepinephrine,sevoflurane,and analgesic drugs 24 h postoperatively;as well as operation time,extubation time,and lengths of postanesthesia care unit(PACU)stay and hospital stay.Results The paravertebral block group had significantly lower ALT on the 1st day after surgery[178.40(126.55,325.86)vs 292.20(197.20,468.95)U/L],SII on the 2nd day after surgery[704.13(486.61,1078.59)vs 1075.09(753.80,1614.38)],and amount of analgesic drugs in 24 h after surgery[29.70(27.37,32.07)vs 31.99(28.92,40.81)mg],and decreased MAP level at T3 and T4,early extubation,and shorter lengths of PACU stay and hospital stay when compared with the control group(all P<0.05).Conclusion Paravertebral nerve block combined with general anesthesia can reduce inflammatory responses,relieve postoperative pain,stabilize hemodynamics for patients undergoing LH,and thereby alleviate postoperative liver injury in them.

关 键 词：椎旁神经阻滞 腹腔镜下肝切除术 肝损伤 术后康复 

分 类 号：R614.24[医药卫生—麻醉学] R614.41[医药卫生—外科学] R657.3[医药卫生—临床医学]