腹腔镜肝切除术治疗肝内胆管结石患者硬膜外自控镇痛效果研究

doi:10.3969/j.issn.1672-5069.2025.01.038

摘要/Abstract

摘要： 目的分析比较腹腔镜肝段切除术治疗肝内胆管结石患者不同镇痛方法的镇痛效果。方法 2020年1月～2024年7月我院收治的肝内胆管结石患者78例,均接受腹腔镜肝段切除术治疗。在完成手术后,将患者分成两组,分别行硬膜外自控镇痛(CEA,n=40)和静脉自控镇痛(CIA,n=38)。应用疼痛数字评价量表(NRS)评估疼痛程度,采用ELISA法检测血清白细胞介素(IL)-6、IL-8和IL-10水平,采用ELISA法检测血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)和丙二醇(MDA)水平。结果在术后6 h、12 h、24 h和48 h,CEA组动态NRS评分分别为(3.8±1.2)分、(3.5±1.)分、(3.1±0.9)分和(2.5±0.7)分,均显著低于CIA组【分别为(4.1±1.2)分、(4.4±1.2)分、(3.9±1.0)分和(3.2±0.8)分,P＜0.05】;在术后48 h内,CEA组总按压镇痛泵次数为(8.5±2.2)次,有效按压镇痛泵次数为(7.3±1.7)次,均显著少于CIA组【分别为(10.7±3.4)次和(10.0±2.2)次,P＜0.05】;CEA组血清IL-6和IL-8水平分别为(26.4±4.9)ng/ml和(25.5±5.4)ng/ml,均显著低于CIA组【分别为(42.6±5.2)ng/ml和(35.1±5.6)ng/ml,P＜0.05】,而血清IL-10水平为(44.1±3.9)pg/ml,显著高于CIA组【(27.6±4.0)pg/ml,P＜0.05】; CEA组血清Cor、ACTH和MDA水平分别为(318.5±58.3)mmol/L、(19.6±4.3)pmol/L和(3.4±0.8)mmol/mL,均显著低于CIA组【分别为(375.9±66.4)mmol/L、(25.9±5.6)pmol/L和(4.3±1.0)mmol/mL,P＜0.05】。结论采用硬膜外自控镇痛处理接受腹腔镜肝段切除术治疗的肝内胆管结石患者有良好的镇痛效果,可能与减轻了应激反应,降低细胞因子分泌有关,值得进一步观察。

关键词: 肝内胆管结石, 腹腔镜肝段切除术, 硬膜外自控镇痛, 静脉自控镇痛,镇痛

Abstract: Objective The aim of this study was to investigate patient controlled epidural analgesia (CEA) in patients with hepatolithiasis after laparoscopic hepatectomy (LH). Methods A total of 78 patients with hepatolithiasis were encountered in our hospital between January 2020 and July 2024, and all underwent LH. On support of induction and maintenance anesthesia, the operation was finished. After completion of surgery, patients were assigned to receive CEA (n=40) or patient controlled intravenous analgesia (CIA, n=38) for post-operational analgesia. Numerical rating scale (NRS) was evaluated, serum interleukin (IL)-6, IL-8 and IL-10 levels were detected by ELISA, and serum cortisol (Cor), adrenocorticotropic hormore (ACTH) and malondialdehyde (MDA) levels were assayed by ELISA. Results At 6 h, 12 h, 24 h and 48 h after surgery, dynamic NRS scores in CEA group were(3.8±1.2), (3.5±1.), (3.1±0.9) and (2.5±0.7), all significantly lower than(4.1±1.2), (4.4±1.2), (3.9±1.0) and (3.2±0.8), respectively, ,P＜0.05] in CIA group; within 48 h since termination of operation, total compression on analgesic pumps in CEA group was(8.5±2.2)times, and effective compression was o(7.3±1.7)times, both much less than [(10.7±3.4)times and (10.0±2.2)times, respectively, P＜0.05] in CIA group; serum IL-6 and IL-8 levels in CEA group were (26.4±4.9)ng/ml and (25.5±5.4)ng/ml, both significantly lower than [(42.6±5.2)ng/ml and (35.1±5.6)ng/ml, respectively, P＜0.05], while serum IL-10 level was (44.1±3.9)pg/ml, much higher than [(27.6±4.0)pg/ml, P＜0.05] in CIA group; serum Cor, ACTH and MDA levels in CEA group were (318.5±58.3)mmol/L, (19.6±4.3)pmol/L and (3.4±0.8)mmol/mL, all significantly lower than [(375.9±66.4)mmol/L, (25.9±5.6)pmol/L and (4.3±1.0)mmol/mL, respectively, P＜0.05] in CIA group. Conclusion CEA has a satisfactory analgesic effect in patients with hepatolithiasis after LH, which might be related to inhibition of stress inflammatory reactions, with less cytokine secretion.

Key words: Hepatolithiasis, Laparoscopic hepatectomy, Patient controlled epidural analgesia, Patient controlled intravenous analgesia, Analgesia

廖余红, 资瑜, 罗剑平. 腹腔镜肝切除术治疗肝内胆管结石患者硬膜外自控镇痛效果研究[J]. 实用肝脏病杂志, 2025, 28(1): 148-151.

Liao Yuhong, Zi Yu, Luo Jianping. Patient controlled epidural analgesia in patients with hepatolithiasis after laparoscopic hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(1): 148-151.

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