椎旁阻滞联合全身麻醉在肝血管瘤切除术中的应用和效果研究

doi:10.3969/j.issn.1672-5069.2018.04.030

摘要/Abstract

摘要： 目的研究椎旁阻滞联合全身麻醉在预防肝血管瘤切除患者术后疼痛的效果。方法 2014年6月~2016年12月收治的肝血管瘤患者123例,采用数字奇偶法分为观察组62例和对照组61例,在行手术切除肿瘤时分别采用全身麻醉联合椎旁阻滞麻醉或仅采取全身麻醉。采用视觉模拟疼痛评分法（VAS）测定疼痛程度,采用ELISA法检测血清肿瘤坏死因子α（TNF-α）和可溶性髓样细胞触发受体-1（sTREM-1）。结果术后3 h、24 h和48 h,观察组VAS评分分别为（3.6±1.1）分、（3.1±0.9）分和（2.9±0.7）分,显著低于对照组【分别为（4.5±1.5）分、（3.8±1.2）分和（3.5±1.0）,P<0.05】;术后24 h和72 h,观察组血清TNF-α水平分别为（135.1±21.8） pg/mL和（99.3±18.2） pg/ml,显著低于对照组【（230.5±32.1） pg/ml和（183.7±22.7） pg/ml,P<0.05】,血清sTREM-1水平分别为（215.9±29.6） pg/ml和（168.5±25.3） pg/ml,显著低于对照组【（295.4±41.6） pg/ml和（241.8±27.4） pg/ml,P<0.05】;观察组术后拔管时间为（5.3±1.9）h,显著短于对照组【（6.3±2.1） h,P<0.05】,住ICU时间为（25.5±8.6） h,明显短于对照组【（31.6±9.8） h,P<0.05】,住院日为（9.4±2.1） d,明显短于对照组【（10.6±2.4） d,P<0.05】,舒芬太尼用量为（1.5±0.3） mg,明显低于对照组【（2.5±0.4） mg,P<0.05】;术后恢复进食时间为（2.3±0.5） d,明显短于对照组【（3.5±0.6） d,P<0.05】;观察组疼痛相关不良事件发生率为16.2%,明显低于对照组的34.4%（P<0.05）。结论在全身麻醉的基础上增加椎旁阻滞麻醉有助于减轻肝血管瘤切除患者术后疼痛程度,减少疼痛相关不良事件,促进康复。

关键词: 肝血管瘤, 椎旁阻滞麻醉, 术后疼痛, 细胞因子

Abstract: Objective To investigate the application of paravertebral block anesthesia combined with general anesthesia in patients with hepatic hemangioma resection. Methods 123 patients with hepatic hemangioma were admitted to our hospital between June 2014 and December 2016,and were divided into observation group （n=62） and control group（n=61） by digital parity method, receiving general and paravertebral block anesthesia,or general anesthesia alone when resection of hepatic hemangioma underwent. The degree of pain was determined by visual analogue pain score （VAS）,and serum levels of tumor necrosis factor alpha （TNF-α） and soluble triggering receptor expressed on myeloid cell-1（sTREM-1） were measured by enzyme-linked immunosorbent assay. Results At 3 h,24 h and 48 h post-operation,the VAS scores in the observation group were（3.6±1.1）,（3.1 ± 0.9） and （2.9±0.7）,respectively,significantly lower than [（4.5±1.5）,（3.8±1.2） and （3.5±3.5）,P<0.05] in the control group; at 24 h and 72 h postoperation,serum TNF-α levels in the observation group were（135.1±21.8）pg/ml and （99.3±18.2） pg/ml,much lower than【（230.5±32.1） pg/ml and （183.7±22.7）pg/ml,P<0.05】 in the control,and serum sTREM-1 levels were（215.9±29.6）pg/ml and （168.5±25.3） pg/ml,also much lower than 【（295.4±41.6）pg/ml and（241.8±27.4）pg/ml,P<0.05】 in the control group;the extubation time after surgery in the observation group was （5.3±1.9） h,significantly shorter than [（6.3±2.1） h,P<0.05],the duration of ICU stay was （25.5±8.6） h,significantly shorter than [（31.6±9.8） h,P<0.05],the hospitalization stay was （9.4±2.1） d,much shorter than [（10.6±2.4） d,P<0.05],and the dosage of sufentanil administration was（1.5±0.3） mg,significantly lower than [（2.5±0.4） mg,P<0.05] in the control;the total incidence of pain related adverse events in the observation group was 16.2,significantly lower than 34.4% in the control（P<0.05）. Conclusion The paraspinal block anesthesia at the basis of general anesthesia might reduce the postoperative pain, get down blood inflammatory factor levels,and decrease pain related adverse events in patients with hepatic hemangioma resection.

Key words: Hepatic hemangioma, Surgical resection, Paravertebral block anesthesia, Postoperative pain, Cytokines

秦文英, 陈丽华, 于国军. 椎旁阻滞联合全身麻醉在肝血管瘤切除术中的应用和效果研究[J]. 实用肝脏病杂志, 2018, 21(4): 605-608.

Qin Wenying, Chen Lihua, Yu Guojun. Application of paravertebral block anesthesia combined with general anesthesia in patients with hepatic hemangioma resection[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 605-608.

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