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中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 189 -194. doi: 10.3877/cma.j.issn.2095-3232.2024.02.012

临床研究

不同时机局部神经阻滞在开腹肝切除中的镇痛效果比较
张婵1, 吕瑶1, 张小燕2, 张鸣青1,()   
  1. 1. 363000 福建省漳州市,第九〇九医院(厦门大学附属东南医院)消化内科
    2. 363000 福建省漳州市,第九〇九医院(厦门大学附属东南医院)麻醉科
  • 收稿日期:2024-01-02 出版日期:2024-04-10
  • 通信作者: 张鸣青
  • 基金资助:
    福建省自然科学基金(2021J01545)

Comparison of analgesic effects of regional nerve blocks at different time points in open hepatectomy

Chan Zhang1, Yao Lyu1, Xiaoyan Zhang2, Mingqing Zhang1,()   

  1. 1. Department of Gastroenterology, the No.909 Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
    2. Department of Anesthesiology, the No.909 Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
  • Received:2024-01-02 Published:2024-04-10
  • Corresponding author: Mingqing Zhang
引用本文:

张婵, 吕瑶, 张小燕, 张鸣青. 不同时机局部神经阻滞在开腹肝切除中的镇痛效果比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 189-194.

Chan Zhang, Yao Lyu, Xiaoyan Zhang, Mingqing Zhang. Comparison of analgesic effects of regional nerve blocks at different time points in open hepatectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 189-194.

目的

探讨不同时机腹横肌平面阻滞在开腹肝切除患者中的镇痛效果。

方法

回顾性分析2020年1月至2021年12月第九〇九医院行开腹肝切除的117例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男75例,女42例;年龄37~59岁,中位年龄50岁。根据腹横肌平面阻滞时机分为术前组(56例)和术后组(61例)。对比两组阻滞持续时间,24 h舒芬太尼用量,术后第12、24 h视觉模拟评分(VAS)和舒适度评分(BCS),TNF-α、IL-1、皮质醇(Cor)、促肾上腺皮质激素(ACTH)及不良反应发生等。两组围手术期指标比较采用t检验,不良反应比较采用χ2检验。

结果

术前组阻滞持续时间平均为(12.6±2.2)h,明显短于术后组的(14.9±3.1)h(t=-5.945,P<0.05);术前组术后24 h舒芬太尼按压次数为(5.7±1.5)次,明显高于术后组的(4.4±1.3)次(t=5.243,P<0.05)。术前组术后12、24 h的VAS分别为(3.6±0.9)、(3.8±0.9)分,明显高于术后组的(3.0±0.8)、(3.1±0.6)分(t=4.074,4.654;P<0.05)。术前组术后12、24 h的BCS分别为(1.6±0.8)、(1.5±0.8)分,明显低于术后组(2.0±0.8)、(1.9±0.8)分(t=-2.763,-3.048;P<0.05)。术前组术后1 d的TNF-α、IL-1、Cor、ACTH分别为(5.4±1.4)μg/L、(77±14)ng/L、(246±22)mmol/L、(75±9)ng/L,明显高于术后组的(4.2±1.5)μg/L、(54±11)ng/L、(217±20)mmol/L、(60±10)ng/L(t=4.491,8.770,9.509,10.260;P<0.05)。两组头痛头晕、恶心呕吐、皮肤瘙痒分别为2、2、1例和3、2、2例,不良反应发生率差异无统计学意义(P>0.05)。

结论

术后行腹横肌平面阻滞可延长神经阻滞时间,提高患者舒适度,改善镇痛效果,可能与降低炎症因子和应激激素水平有关,同时不会延缓术后康复和增加不良反应发生率,是一种可供选择的围手术期镇痛方案。

Objective

To evaluate the analgesic effects of transverse abdominis plane blocks at different time points in patients undergoing open hepatectomy.

Methods

Clinical data of 117 patients who underwent open hepatectomy in the No.909 Hospital from January 2020 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 75 patients were male and 42 female, aged from 37 to 59 years, with a median age of 50 years. According to the time points of transverse abdominis plane blocks, all patients were divided into the preoperative (n=56) and postoperative groups (n=61). The duration of block, sufentanil dosage at 24 h, visual analogue scale (VAS) and Bruggrmann comfort scale (BCS) scores at postoperative 12 and 24 h, TNF-α, IL-1, cortisol (Cor), adrenocorticotropic hormone (ACTH) and the incidence of adverse reactions were statistically compared between two groups. Perioperative indexes were compared by t test, and the incidence of adverse reactions was compared by Chi-square test.

Results

In the preoperative group, the average duration of transverse abdominis plane block was (12.6±2.2) h, significantly shorter than (14.9±3.1) hin the postoperative group (t=-5.945, P<0.05). In the preoperative group, the number of patient-controlled analgesia (PCIA) compressions at postoperative 24 h was (5.7±1.5) times, which was significantly higher than (4.4±1.3) times in the postoperative group (t=5.243, P<0.05). In the preoperative group, the VAS scores at postoperative 12 and 24 h were 3.6±0.9 and 3.8±0.9, significantly higher than 3.0±0.8 and 3.1±0.6 in the postoperative group (t=4.074, 4.654; P<0.05). In the preoperative group, the BCS at postoperative 12 and 24 h was 1.6±0.8 and 1.5±0.8, significantly lower than 2.0±0.8 and 1.9±0.8 in the postoperative group(t=-2.763, -3.048; P<0.05). In the preoperative group, TNF-α, IL-1, Cor and ACTH levels at postoperative1 d were (5.4±1.4) μg/L, (77±14) ng/L, (246±22) mmol/L and (75±9) ng/L, significantly higher than (4.2±1.5) μg/L,(54±11) ng/L, (217±20) mmol/L and (60±10) ng/L in the postoperative group (t=4.491, 8.770, 9.509, 10.260; P<0.05). In the preoperative group, 2 patients developed headache and dizziness, 2 cases of nausea and vomiting and 1 case of skin itching, and 3, 2 and 2 cases in the postoperative group, respectively. The differences were not statistically significant in the incidence of adverse reactions (P>0.05).

Conclusions

Postoperative transverse abdominis plane block can prolong the duration of nerve block, improve the comfort level of patients and enhance the analgesic effect, which may be associated with reducing the levels of inflammatory cytokines and stress hormones. In addition, it does not delay postoperative rehabilitation or increase the incidence of adverse reactions, which can be used as an optional perioperative analgesic protocol.

表1 术前组和术后组开腹肝切除患者一般资料比较
表2 术前组和术后组开腹肝切除患者阻滞效果对比
表3 术前组和术后组开腹肝切除患者术后VAS疼痛评分比较(±s
表4 术前组和术后组开腹肝切除患者炎症因子和应激指标比较(±s
表5 术前组和术后组开腹肝切除患者术后恢复及不良反应情况比较
[1]
Nimmo SM, Foo ITH, Paterson HM. Enhanced recovery after surgery: pain management[J]. J Surg Oncol, 2017, 116(5):583-591.
[2]
Tao KM, Xu HH, Zhu CC, et al. Serratus anterior plane block catheter for hepatectomy: a method to decrease opioid use perioperatively[J]. J Clin Anesth, 2020(61):109682.
[3]
Zhu Q, Li L, Yang Z, et al. Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial[J]. BMC Anesthesiol, 2019, 19(1):23.
[4]
陈鹭, 林健清, 梁敏, 等. 腹横肌平面阻滞联合全身麻醉在老年患者肝切除术中的应用[J]. 临床麻醉学杂志, 2020, 36(4):392-394.
[5]
陈佳婷, 谭雷, 杨小立, 等. 三种不同入路超声引导腹横肌平面阻滞在肝癌切除术中镇痛效果比较[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 9(3):269-273.
[6]
Hamed MA, Goda AS, Basiony MM, et al. Erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy: a randomized controlled study original study[J]. J Pain Res, 2019(12):1393-1398.
[7]
Lim S, Carabini LM, Kim RB, et al. Evaluation of American Society of Anesthesiologists classification as 30-day morbidity predictor after single-level elective anterior cervical discectomy and fusion[J]. Spine J, 2017, 17(3):313-320.
[8]
Statzer N, Cummings KC 3rd. Transversus abdominis plane blocks[J]. Adv Anesth, 2018, 36(1):163-180.
[9]
Rafi AN. Abdominal field block: a new approach via the lumbar triangle[J]. Anaesthesia, 2001, 56(10):1024-1026.
[10]
曹寅, 徐静静, 余秀国, 等. 腹横肌平面阻滞对全麻腹腔镜手术老年患者术后认知功能的影响[J]. 中华麻醉学杂志, 2019, 39(2):139-142.
[11]
Abdel-Ghaffar HS, Askar FGE, Mohamed HH, et al. Analgesic and respiratory effects of two doses of morphine as an adjunct to bupivacaine in ultrasound-guided transversus abdominis plane block in upper abdominal surgery[J]. Pain Physician, 2019, 22(5):509-517.
[12]
代元强, 文平山, 陈君, 等. 超声引导下不同浓度罗哌卡因肋缘下入路腹横肌平面阻滞在上腹部手术中的效果[J]. 临床麻醉学杂志, 2018, 34(2):149-152.
[13]
Sá Malheiro N, Afonso NR, Pereira D, et al. Efficacy of ultrasound guided suprascapular block in patients with chronic shoulder pain: retrospective observational study[J]. Braz J Anesthesiol, 2020, 70(1):15-21.
[14]
Zhang J, Liu T, Zhou H, et al. The safety and efficacy of ultrasound-guided bilateral dual transversus abdominis plane (BD-TAP) block in ERAS program of laparoscopic hepatectomy: a prospective, randomized, controlled, blinded, clinical study[J]. Drug Des Devel Ther, 2020(14):2889-2898.
[15]
Trabelsi B, Charfi R, Bennasr L, et al. Pharmacokinetics of bupivacaine after bilateral ultrasound-guided transversus abdominis plane block following cesarean delivery under spinal anesthesia[J]. Int J Obstet Anesth, 2017(32):17-20.
[16]
彭丽, 张琦, 张亚辉, 等. 超声引导下罗哌卡因股神经阻滞感觉运动分离的半数有效浓度[J]. 中华麻醉学杂志, 2020, 40(4):455-457.
[17]
王永徽, 刘广林, 董海龙, 等. 超声引导下三点阻滞与椎旁阻滞用于剖腹肝胆手术术后镇痛的比较[J]. 临床麻醉学杂志, 2020, 36(5):421-424.
[18]
Zhang Q, Piao C, Xu J, et al. Comparative study on protective effect of hydrogen rich saline and adipose-derived stem cells on hepatic ischemia-reperfusion and hepatectomy injury in swine[J]. Biomed Pharmacother, 2019(120):109453.
[19]
孙晓妮, 张军, 李思远. 右美托咪定联合舒芬太尼术后镇痛在宫颈癌根治术患者中的应用效果[J]. 癌症进展, 2022, 20(21):2229-2232.
[20]
Liu F, Xiong LL, Li TT, et al. Analgesic effects and adverse reactions of lidocaine for patient-controlled intravenous analgesia on patients undergoing open hepatectomy: a retrospective analysis[J]. J Perianesth Nurs, 2023, 38(1):39-44.
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