探讨罗哌卡因联合苏芬太尼在肝硬化门静脉高压症患者肝切除术后镇痛中的应用价值。

回顾性分析2015年9月至2016年6月在中山大学附属第三医院行肝切除术的22例肝硬化门静脉高压症患者临床资料。其中男14例，女8例；年龄38～75岁，中位年龄51岁。患者均签署知情同意书，符合医学伦理学规定。根据术后镇痛方法不同，将患者分为罗哌卡因联合苏芬太尼组（联合组，9例）和苏芬太尼组（对照组，13例）。联合组患者采用罗哌卡因切口局部浸润联合苏芬太尼经静脉患者自控镇痛（PCIA）术后镇痛治疗。对照组患者采用单独苏芬太尼PCIA术后镇痛治疗。观察两组患者术后疼痛程度、肝功能、手术切口愈合及并发症发生情况。两组术后疼痛视觉模拟评分（VAS）、肝功能Child-pugh评分比较采用t检验。

联合组术后4、8、12、24、48 h的VAS分别为（2.8±1.2）、（3.1±1.1）、（2.8±0.7）、（2.4±1.0）、（2.4±0.9）分，明显低于对照组的（5.2±1.6）、（5.1±1.4）、（4.9±1.4）、（4.5±1.0）、（3.5±1.1）分（t=-3.82，-3.49，-4.30，-4.90，-2.56；P<0.05）。两组患者手术切口愈合良好，均为Ⅱ/甲。联合组未发生下肢深静脉血栓或肺栓塞；对照组1例术后发生左下肢深静脉血栓及轻度肺栓塞，经保守治疗后好转。

罗哌卡因切口局部浸润联合苏芬太尼PCIA术后镇痛，能有效改善肝硬化门静脉高压症患者肝切除术后疼痛，加速患者康复，是一种安全、有效的联合镇痛方式。

To investigate the application value of ropivacaine combined with sufentanil in the analgesia after hepatectomy in patients with cirrhotic portal hypertension.

Clinical data of 22 patients with cirrhotic portal hypertension who underwent hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University between September 2015 and June 2016 were retrospectively analyzed. Among them, 14 cases were males and 8 females, aged 38-75 years old with a median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the postoperative analgesia method, all patients were divided into the ropivacaine combined with sufentanil group (combination group, n=9) and sufentanil group (control group, n=13). Regional incisional administration of ropivacaine combined with sufentanil via patient controlled intravenous analgesia (PCIA) were used for postoperative analgesia in the combination group, while sufentanil alone via PCIA was used in the control group. The degree of postoperative pain, liver function, healing of surgical incision and incidence of postoperative complications were observed in two groups. The visual analogue scale (VAS) and liver function Child-Pugh score in two groups were compared using t test.

The VAS at postoperative 4, 8, 12, 24 and 48 h in the combination group was respectively 2.8±1.2, 3.1±1.1, 2.8±0.7, 2.4±1.0 and 2.4±0.9, significantly lower than 5.2±1.6, 5.1±1.4, 4.9±1.4, 4.5±1.0 and 3.5±1.1 in the control group (t=-3.82, -3.49, -4.30, -4.90, -2.56; P<0.05). The surgical incisions healed well in both groups and were graded as Ⅱ/A. No lower extremity deep venous thrombosis or pulmonary embolism were observed in the combination group, while postoperative lower extremity deep venous thrombosis and mild pulmonary embolism were observed in 1 case of the control group, and the patient got better after conservative therapy.

Regional incisional administration of ropivacaine combined with sufentanil via PCIA can effectively improve the pain after hepatectomy and accelerate postoperative recovery, which is a safe and efficacious combined-analgesia approach for patients with cirrhotic portal hypertension.