腹横肌平面阻滞联合切口局部浸润麻醉对肝癌术后快速康复的影响 |
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引用本文: | 何欣,赵洪伟,宋天强,杨洋,吕扬. 腹横肌平面阻滞联合切口局部浸润麻醉对肝癌术后快速康复的影响[J]. 中国肿瘤临床, 2018, 45(16): 850-853. DOI: 10.3969/j.issn.1000-8179.2018.16.252 |
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作者姓名: | 何欣 赵洪伟 宋天强 杨洋 吕扬 |
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作者单位: | ①.天津医科大学肿瘤医院麻醉科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心(天津市 300060) |
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摘 要: | 目的 观察腹横肌平面阻滞联合切口局部浸润麻醉在肝癌手术患者快速康复外科中的应用价值。 方法 选择2017年2月至2017年10月天津医科大学肿瘤医院全身麻醉下经腹行肝癌切除手术的患者60例,随机分为2组(n=30):全身麻醉复合腹横肌平面阻滞(transversus abdominis plane block,TAPB)及切口局部浸润麻醉组(T组)和对照组即单纯全身麻醉组(C组)。记录围术期血流动力学变化;术中七氟醚、瑞芬太尼的用量以及术后使用PCIA补救性镇痛按压次数;记录患者术后苏醒时间、术后2 h、4 h、6 h、24 h的VAS评分;术后不良反应发生率、炎症因子水平以及患者康复状况。 结果 围术期试验组的血流动力学较对照组平稳;术中麻醉药用量比较试验组明显少于对照组(P < 0.05),且患者苏醒时间、拔管时间、定向力恢复时间和恶心呕吐不良反应的发生率明显低于对照组(P < 0.05);与对照组比较试验组术后2、4、6 h的VAS评分显著降低,差异有统计学意义(P < 0.05),静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)追加总次数明显少于对照组(P < 0.05);试验组在术后4 h和24 h的炎性因子CRP、TNF-α、IL-6水平明显低于对照组(P < 0.05),试验组术后首次下床活动时间[(26.2±7.6)vs.(37.2±10.4)h]、胃肠道恢复时间[(37.8±13.1)vs.(44.7±13.7)h]和术后住院时间[(6.1±0.7)vs.(8.1±0.9)d]均少于对照组(P < 0.05)。 结论 超声引导TAPB阻滞联合罗哌卡因切口局部浸润降低了患者对伤害性刺激和疼痛的敏感性,可稳定围术期血流动力学,减少芬太尼等麻醉药用量,缩短苏醒时间,减少术后不良反应概率,减少炎性细胞因子释放,有利于患者术后快速康复。
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关 键 词: | 腹横肌平面阻滞 切口浸润 肝癌 快速康复 |
收稿时间: | 2018-03-13 |
Effects of transversus abdominis plane block combined with incision local infiltration anesthesia on early recovery in patients with hepatocellular carcinoma undergoing hepatectomy |
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Abstract: | Objective To investigate the value of transversus abdominis plane block (TAPB) combined with incision local infiltration anesthesia used in patients with hepatocellular carcinoma for recovery after surgery. Methods Sixty patients with liver cancer undergoing abdominal surgery under general anesthesia were randomly divided into two groups (n=30 each): general anesthesia combined with TAPB and incision local infiltration anesthesia group (group T) and control group, i.e., general anesthesia alone (group C). Perioperative hemodynamic changes, postoperative patient-controlled intravenous analgesia (PCIA) use (number of presses), intraoperative sevoflurane use, and remifentanil dosage were recorded. The postoperative recovery time; visual analog scale (VAS) score at 2, 4, 6 h, and 24 h postoperatively; adverse reaction rate; level of inflammatory factors; and patient rehabilitation were compared between the two groups. Results In group T, perioperative hemodynamics were more stable than in group C. The anesthetic dosage, recovery time, extubation time, and incidence rate of adverse reactions in group T were significantly lower than those in group C (P < 0.05). The VAS scores at 2, 4, and 6 h after surgery were reduced (P < 0.05), and the times of additional PCIA uses were fewer (P < 0.05) in group T than in group C. The levels of the inflammatory factors CRP, TNF-α, and IL-6 at 4 and 24 h postoperatively were significantly lower in group T than in group C (P < 0.05). In addition, in group T, the postoperative ambulation time [(26.2±7.6) vs. (37.2±10.4) h], gastrointestinal recovery time [(37.8±13.1) vs. (44.7±13.7) h], and postoperative hospitalization time [(6.1±0.7) vs. (8.1±0.9) d] were shorter than those for group C (P < 0.05). Conclusions Ultrasound-guided TAPB combined with ropivacaine local incision infiltration can reduce sensitivity to noxious stimulation and pain, stabilize perioperative hemodynamics, reduce fentanyl anesthetic dosage, shorten recovery time, reduce the probability of adverse reactions, and reduce the release of inflammatory cytokines, thereby rapidly improving the rehabilitation of patients. |
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