腹腔镜肝叶切除术治疗肝内胆管结石患者肋缘下腹横筋膜阻滞预先镇痛效果研究*

doi:10.3969/j.issn.1672-5069.2025.02.036

摘要/Abstract

摘要： 目的探讨肋缘下腹横筋膜阻滞预先镇痛用于腹腔镜肝叶切除术治疗的肝内胆管结石(IHBDS)患者的镇痛效果。方法 2021年1月～2023年12月我院收治的147例IHBDS患者,均接受腹腔镜下肝叶切除术治疗。将患者分为对照组71例和观察组76例,均行全身静脉麻醉,观察组在此基础上实施肋缘下腹横筋膜阻滞预先镇痛。采用视觉模拟疼痛(VAS)评分评估疼痛,采用ELISA法检测血清肾上腺素(E)、去甲肾上腺素(NE)和质醇(Cor)水平。结果观察组肠功能恢复时间和住院日分别为(2.1±0.9)d和(7.1±1.1)d,均显著短于对照组【分别为(3.2±1.1)d和(8.5±1.3)d,P＜0.05】;在术后6 h和24 h,观察组静息时VAS评分分别为(1.9±0.5)分和(2.2±0.5)分,均显著低于对照组【分别为(2.9±0.3)分和(2.8±0.5)分,P＜0.05】,活动时VAS评分分别为(2.4±0.3)分和(2.6±0.5)分,均显著低于对照组【分别为(3.4±0.5)分和(3.4±0.7)分,P＜0.05】;在T1～T4时,两组心率(HR)和平均动脉压(MAP)比较均无显著性差异(P＞0.05);术后,观察组血清E和Cor水平分别为(200.1±27.4)pg/ml和(262.1±28.4)pg/ml,均显著低于对照组【分别为(240.3±33.5)pg/ml和(301.7±31.2)pg/ml,P＜0.05】;两组围术期不良反应发生率(9.8%对7.8%,P＞0.05)也无显著性差异。结论采用肋缘下腹横筋膜阻滞预先镇痛可缩短腹腔镜肝叶切除术治疗的IHBDS患者住院时间,术后镇痛效果好,可能与抑制了机体应激反应有关。

关键词: 肝内胆管结石, 腹腔镜肝叶切除术, 腹横筋膜阻滞, 预先镇痛

Abstract: Objective The aim of this study was to observe analgesic efficacy of preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones (IHBDS) undergoing laparoscopic hepatectomy (LH). Methods A total of consecutive 147 patients with IHBDS were encountered in our hospital between January 2021 and December 2023, and all patients underwent LH for removal of diseased liver lobe. Before anesthesia, patients were divided into two groups, 71 patients in the control received general intravenous anesthesia, while 76 patients in the observation group received preemptive analgesia with subcostal transverse fascial block and then the general anesthesia same as in the control. Visual analogue scale (VAS) was applied to assess post-operational pain, and serum epinephrine (E), norepinephrine (NE) and cortsisol (Cor) levels were assayed by ELISA. Results Intestinal function resumed and hospital stay in the observation were(2.1±0.9)d and (7.1±1.1)d, both much shorter than [(3.2±1.1)d and (8.5±1.3)d, respectively, P＜0.05] in the control; by 6 h and 24 h, resting VAS scores in the observation were (1.9±0.5) points and (2.2±0.5)points, both significantly lower than [(2.9±0.3)points and (2.8±0.5)points, respectively, P＜0.05], and VAS score at motion were (2.4±0.3) points and (2.6±0.5)points, both significantly lower than [(3.4±0.5)points and (3.4±0.7)points, P＜0.05] in the control; post-operationally, serum E and Cor levels in the observation were (200.1±27.4)pg/ml and (262.1±28.4)pg/ml, both much lower than [(240.3±33.5)pg/ml and (301.7±31.2)pg/ml, P＜0.05] in the control; there were no significant differences as respect to heart rates or mean arterial pressure at T1 to T4 in the two groups(P＞0.05), and there were also no significant differences respect to adverse effects in the two groups (9.8% vs. 7.8%, P＞0.05). Conclusion Preemptive analgesia by subcostal transverse fascial block could alleviate post-operational pain in patients with IHBDS undergoing LH, which might be related to inhibition of body inflammatory reactions.

Key words: Intrahepatic bile duct stone, Laparoscopic hepatectomy, Transverse fascial block, Subcostal approach, Preemptive analgesia

武倩, 齐少霞, 李东, 周翼, 付征, 闫诺. 腹腔镜肝叶切除术治疗肝内胆管结石患者肋缘下腹横筋膜阻滞预先镇痛效果研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 302-305.

Wu Qian, Qi Shaoxia, Li Dong, et al. Preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(2): 302-305.

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腹腔镜肝叶切除术治疗肝内胆管结石患者肋缘下腹横筋膜阻滞预先镇痛效果研究^*

Preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy

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