不同麻醉方式对腹腔热灌注化疗术患者术后早期疼痛的镇痛效果

目的：探讨全身麻醉联合腹直肌鞘阻滞（RSB）或腹横肌平面阻滞（TAPB）对肿瘤细胞减灭术联合腹腔热灌注化疗术（CRS/HIPEC）患者术后早期疼痛的影响，为实现更优化的麻醉和镇痛方案提供参考。方法：采用回顾性队列研究，纳入本院行CRS/HIPEC术患者。通过查询麻醉记录单收集患者麻醉方法信息，根据不同麻醉方法将患者分为单纯全身麻醉组202例、全身麻醉联合RSB组62例（RSB组）和全身麻醉联合TAPB组54例（TAPB组）。使用倾向性评分匹配3组患者一般资料，匹配后每组患者各35例。3组患者全身麻醉方案一致；RSB组于双侧腹直肌后鞘分别给予0.375%盐酸罗哌卡因20 mL，TAPB组患者于双侧腹横肌平面分别给予0.375%盐酸罗哌卡因20 mL。记录3组患者术中血流动力学指标变化、手术全程时间和术毕拔管时间，麻醉恢复期高血压、苏醒期躁动和恶心呕吐患者发生率，术中瑞芬太尼应用总量和术中肌松药物总量。术后3组患者均给予患者自控静脉镇痛（PCIA），记录患者术后2、6和12 h的视觉模拟评分（VAS）、PCIA输入剂量和按压次数。结果：3组患者基线资料比较差异无统计学意义（P>0.05），血流动力学指标和手术时间比较差异无统计学意义（P>0.05）。RSB组和TAPB组患者术毕拔管时间、术中瑞芬太尼用量和肌松药用量明显低于单纯全身麻醉组（P<0.05）。RSB组和TAPB组患者麻醉恢复期高血压、苏醒期躁动和恶心呕吐发生率明显低于单纯全身麻醉组（P<0.05）。与单纯全身麻醉组比较，RSB组和TAPB组患者术后2和6 h VAS评分、PCIA输入剂量和按压次数均明显降低（P<0.05）。结论：全身麻醉联合RSB和全身麻醉联合TAPB在CRS/HIPEC术中可维持患者术中血流动力学稳定，患者术后早期镇痛效果佳，是一种更加优化的麻醉方案。

Analgesic effects of different anesthesia methods on early pain of patients after hyperthermie intraperitoneal chemotherapy

Objective: To explore the effects of general anesthesia combined with rectus sheath block(RSB) or transverse abdominis plane block(TAPB) on the early pain of the patients after cytoreductive surgery combined with hyperthermie intraperitoneal chemotherapy (CRS/HIPEC), and to provide a reference for performing more optimized anesthesia and analgesia program. Methods: A retrospective cohort study was conducted and the patients underwent CRS/HIPEC in our hospital were selected. The information of anesthesia method was collected by inquiring anesthesia record sheet. According to the different anesthesia methods, the patients were divided into simple general anesthesia group(n=202), general anesthesia combined with RSB group (RSB group) (n=62)and general anesthesia combined with TAPB group (TAPB group)(n=54). Using propensity score to match the general data of three groups, 35 patients in each group were matched. The patients in three groups received the same general anesthesia plan. In RSB group, 0.375% ropivacaine hydrochloride 20 mL was given to the posterior sheath of bilateral rectus abdominis of the patients, and in TAPB group, 0.375% ropivacaine hydrochloride 20 mL was given to the plane of bilateral transverse abdominis of the patients. The changes of hemodynamic indexes, the whole time of operation, the time of extubation after operation, the incidence of hypertension, emergence agitation, nausea and vomiting during the recovery period of anesthesia, the total amount of remifentanil and the total amount of muscle relaxant during operation of the patients in three groups were recorded. All patients in three groups were given patient controlled intravenous analgesia(PCIA), and visual analogue score (VAS), PCIA input dose and pressing times of the patients were recorded at 2, 6 and 12 h after operation. Results: There were no significant differences in baseline data among three groups(P>0.05). and there were no significant differences in the hemodynamic indexes and operation time(P>0.05). The extubation time, remifentanil dosage and muscle relaxant dosage of the patient in RSB group and TAPB group were significantly lower than those in simple general anesthesia group(P<0.05). The incidence of hypertension, emergence agitation, nausea and vomiting in recovery period of the patients in RSB group and TAPB group were significantly lower than those in simpe general anesthesia group(P<0.05). Compared with simple general anesthesia group, the VAS, the PCIA input doses and pressing times of the patients in RSB group and TAPB group were significantly decreased in 2 and 6 h after operation(P<0.05). Conclusion: General anesthesia combined with RSB and general anesthesia combined with TAPB in the CRS/HIPEC operation mode can maintain the hemodynamic stability of the patients during operation, and the early postoperative analgesia effect of the patients is better, so it is a more optimized anesthesia scheme.