全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究*

doi:10.3969/j.issn.1672-5069.2024.06.036

摘要/Abstract

摘要： 目的探讨采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处理外科手术治疗的肝内胆管结石(IHS)患者术后镇痛效果。方法 2020年4月～2024年1月我院收治的60例IHS患者,均接受外科手术切除含有结石的肝组织。在麻醉镇痛时,将患者分成两组,其中在28例对照组采用胸椎旁神经阻滞,在32例观察组采用前锯肌平面阻滞和腹直肌后鞘阻滞,比较两组包括麻醉恢复室(PACU)停留时间等手术指标,采用Ramsay镇静评分及静息和活动时视觉模拟评分(VAS),采用术后恢复质量量表(QoR-40)评估恢复质量。结果观察组PACU停留时间为(35.1±2.0)min,显著短于对照组【(40.3±2.1)min,P＜0.05】;在术后2 h和24 h时,观察组静息VAS评分分别为(2.9±1.4)分和(2.5±1.1)分,显著低于对照组【分别为(3.7±1.7)分和(3.3±1.4)分,P＜0.05】,活动VAS评分分别为(3.7±1.6)分和(2.9±1.5)分, 显著低于对照组【分别为(4.4±1.5)分和(3.6±1.4)分,P＜0.05】;观察组疼痛感受、身体舒适度和QoR-40总分分别为(35.3±1.2)分、(52.8±2.3)分和(175.0±8.0)分,均显著高于对照组【分别为(28.4±1.5)分、(45.8±2.8)分和(165.1±9.7)分,P＜0.05】。结论在行外科手术切除HIS患者肝内结石时,采用全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞的镇痛效果比较好,可以提高患者舒适度。

关键词: 肝内胆管结石, 前锯肌平面阻滞, 腹直肌后鞘阻滞, 全身麻醉, 镇痛

Abstract: Objective The aim of this study was to investigate application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone (IHS) removal. Methods 60 patients with HIS were encountered in our hospital between April 2020 and January 2024, and all underwent surgery operation for removal of the stones under general anesthesia. For analgesia, patients were divided into control (n=28), receiving thoracic paravertebral nerve block, and observation (n=32), receiving serratus anterior plane block and posterior rectus sheath block. Post-anesthesia care unit (PACU) stay and other operation parameters were recorded, Ramsay sedation scores, resting and motion visual analogue scale (VAS) scores, and quality of recovery-40 questionnaire (QoR-40) were assessed. Results PACU stay in the observation was (35.1±2.0)min, much shorter than [(40.3±2.1)min,P＜0.05] in the control; by 2 and 24 hours after operation, resting VAS scores in the observation were(2.9±1.4)points and (2.5±1.1)points, both significantly lower than [(3.7±1.7)points and (3.3±1.4)points, respectively, P＜0.05], and motion VAS scores were (3.7±1.6)points and (2.9±1.5)points, both significantly lower than [(4.4±1.5)points and (3.6±1.4)points, P＜0.05] in the control; pain perception, physical comfort and postoperative QoR-40 score in the observation were (35.3±1.2)points, (52.8±2.3)points and (175.0±8.0)points, all significantly higher than [(28.4±1.5)points, (45.8±2.8) points and (165.1±9.7)points, respectively, P＜0.05] in the control. Conclusion In patients with HIS undergoing surgery operation for removal of stones under general anesthesia, serratus anterior plane block and posterior rectus sheath block have a satisfactory analgesic effects, and improve quality of recovery.

Key words: Intrahepatic bile duct stones, General anesthesia, Serratus anterior plane block, Posterior rectus sheath block, Analgesia

韩洋, 张莉莉, 王雨峰, 贾倩倩. 全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 943-946.

Han Yang, Zhang Lili, Wang Yufeng, et al. Application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone removal[J]. Journal of Practical Hepatology, 2024, 27(6): 943-946.

参考文献

[1] Yang Y, Qiu J, Zhu L. Analysis of EBN interventions in the perioperative period of minimally invasive surgery for intrahepatic and extrahepatic bile duct stones. Altern Ther Health Med, 2022, 28(7):139-145.
[2] Qin J, He Y, Ma L, et al. Efficacy of 3D-printed assisted percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy for intrahepatic bile duct stones. Dig Liver Dis, 2023, 55(12):1699-1704.
[3] Ogura T, Kawai J, Nishiguchi K, et al. Transluminal intrahepatic bile duct stone removal using a novel spiral basket catheter via the endoscopic ultrasound-guided hepaticogastrostomy route (with video). Dig Endosc, 2022, 34(1):234-237.
[4] Zhang WL, Fang ZP, Shi BY, et al. Low-pressure pulse flushing choledochoscopy combined with neodymium laser lithotripsy for the treatment of intrahepatic bile duct stones. Hepatobiliary Pancreat Dis Int, 2021, 20(4):383-386.
[5] 柴鸣,张同军,赵海蕊.直视下与超声引导下前路胸椎旁神经阻滞在老年患者开胸手术中的镇痛效果.中国老年学杂志,2023,43(4):825-828.
[6] 李丛丛,杨倚天,李娜,等.肝癌切除术麻醉的优化策略:全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞.中华麻醉学杂志,2022,42(1):24-28.
[7] 中华医学会外科学分会胆道外科学组,中国医师协会外科医师分会胆道外科医师委员会.胆道镜在肝胆管结石病诊断与治疗中的应用专家共识(2019年版).中华消化外科杂志,2019,18(7):611-615.
[8] Sveinsdottir H, Borgthorsdottir T, Asgeirsdottir MT, et al. Recovery after same-day surgery in patients receiving general anesthesia: a cohort study using the quality of Recovery-40 Questionnaire. J Perianesth Nurs, 2016, 31(6):475-484.
[9] Liu B, Ma J, Li S, et al. Percutaneous transhepatic papillary balloon dilation versus endoscopic retrograde cholangiopancreatography for common bile duct Stones: a multicenter prospective study. Radiology, 2021, 300(2):470-478.
[10] Blanco R, Parras T, Mcdonnell J G, et al. Serratus plane block:a novel ultrasound-guided thoracic wall nerve block. Anaesthesia, 2013, 68(11): 1107-1113.
[11] Visoiu M, Hauber J, Scholz S. Single injection ultrasound-guided rectus sheath blocks for children: Distribution of injected anesthetic. Paediatr Anaesth, 2019, 29(3):280-285
[12] 孙晓佳,汪业铭,孟晨雪,等.超声引导下腰方肌外侧路阻滞联合少阿片类药物麻醉对老年腹腔镜肾癌根治术患者的影响.中国现代医学杂志,2023,33(23):85-91.
[13] Baldo BA. Toxicities of opioid analgesics: respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity. Arch Toxicol, 2021, 95(8):2627-2642.
[14] 于丽丽,宋盼盼,李春雷,等.腹横肌平面-腹直肌鞘阻滞联合全麻用于腹腔镜胰十二指肠切除术患者的改良效果.中华麻醉学杂志,2021,41(3):306-310.
[15] Kim S, Bae CM, Do YW, et al. Serratusanterior plane block and intercostal nerve block after thoracoscopic surgery. Thorac Cardiovasc Surg, 2021, 69(6):564-569.
[16] Ziacchi M, Bisignani G, Palmisano P, et al. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case-control analysis. J Cardiovasc Electrophysiol, 2020, 31(1):144-149.
[17] Xie C, Ran G, Chen D, et al. A narrative review of ultrasound-guided serratus anterior plane block. Ann Palliat Med, 2021, 10(1):700-706.
[18] Harrington C, Bliss J, Lam L, et al. Serratus anterior plane block for clinically suspected rib fractures in prehospital and retrieval medicine. Prehosp Emerg Care, 2024, 28(1):30-35.
[19] Albokrinov AA, Perova-Sharonova VM, Fesenko UA. A new neurostimulator guided technique of rectus sheath block: study of feasibility and local anesthetic spread in children. Anaesthesiol Intensive Ther, 2019, 51(2):83-87.
[20] 雷宇,罗良英,罗敏,等.超声引导前锯肌平面阻滞与胸神经Ⅱ型阻滞用于全麻乳腺癌改良根治术患者围术期镇痛效果的比较.中华麻醉学杂志,2022,42(5):565-568.

全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究^*

Application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone removal

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张晓云, 夏婧, 张智华, 黄松梅. 罗哌卡因腹横肌平面阻滞麻醉处理腹腔镜下肝癌切除术患者镇痛效果分析^*[J]. 实用肝脏病杂志, 2024, 27(5): 773-776.
[2]	冯梁, 林静, 高敏, 雷宇. 肝内胆管结石患者接受腹腔镜下肝叶切除术竖脊肌平面阻滞与腹横肌平面阻滞镇痛效果对比研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 789-792.
[3]	解飞, 胡艳丽, 周海, 徐夏. 环泊酚与小剂量右美托咪定复合镇痛腹腔镜胆囊切除术治疗胆囊结石患者麻醉效果研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 462-465.
[4]	楼鹏, 邓继红, 严铭一. 腹腔镜肝切除术治疗原发性肝癌患者应用右美托咪定复合布托啡诺术后镇痛效果研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 899-902.
[5]	程辉, 刘万清, 张琴. 罗哌卡因联合曲安奈德腹横肌平面阻滞在腹腔镜下肝癌切除术患者术后镇痛中的应用价值研究^*[J]. 实用肝脏病杂志, 2023, 26(5): 710-713.
[6]	祝立刚, 汪涛, 周魏巍, 何彦安, 程龙. 腹腔镜肝切除术与经皮经肝穿刺胆道镜取石术治疗肝内胆管结石患者效果比较^*[J]. 实用肝脏病杂志, 2023, 26(3): 436-439.
[7]	尹秋实, 王学国, 宋奇锋. 腹腔镜肝切除术治疗肝内胆管结石病患者临床疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(1): 124-127.
[8]	迪力旦·纳斯尔, 赵亮, 尼加提江·艾比不拉, 排祖拉·沙拉依阿当. 胆肠Roux-en-Y吻合术留置皮下空肠盲袢治疗肝内胆管结石患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(5): 734-737.
[9]	郭景龙, 石保昌, 张洪战. 胆肠Roux-en-Y吻合术联合留置皮下空肠盲袢取石治疗肝内胆管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 738-741.
[10]	林益坤, 谢朗, 符剑鸣, 崔春晖. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析^*[J]. 实用肝脏病杂志, 2022, 25(4): 591-594.
[11]	孙浩, 曹丽, 曹林, 龙云. 腹腔镜肝切除术治疗原发性肝癌患者应用氢吗啡酮联合纳布啡静脉自控镇痛控制疼痛作用研究^*[J]. 实用肝脏病杂志, 2022, 25(3): 415-418.
[12]	王领, 魏志力, 宋平辉. CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2022, 25(1): 108-111.
[13]	段昌虎, 刘晓晨, 段建峰. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效比较研究^*[J]. 实用肝脏病杂志, 2022, 25(1): 112-115.
[14]	史海军, 张日欣, 宁纯民. 规则性肝叶切除治疗复杂性肝内胆管结石患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(4): 585-588.
[15]	赵闯, 梁超, 董宝剑, 陈祖涛. 原发性肝癌患者接受TACE术时行右美托咪定联合吗啡麻醉临床应用价值分析[J]. 实用肝脏病杂志, 2021, 24(2): 260-263.