摘要
目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)应用加速康复外科(enhanced recovery after surgery,ERAS)理念下不同模式神经阻滞后患者康复质量及安全性分析。方法选取于我院行LC手术患者85例,均给予LC治疗,根据术后神经阻滞模式将患者分为T组(22例)、TR组(20例)、P组(21例)和N组(22例),T组给予右侧肋缘腹横肌平面阻滞(transversus abdominis plane block,TAPB),TR组给予TAPB联合右侧腹直肌鞘阻滞(rectus sheath block,RSB),P组给予静脉自控镇痛,N组不给予镇痛干预,观察各组手术时间、术中出血量、Ramsay镇静评分、视觉模拟评分法(visual analogue scale,VAS)疼痛评分等差异。结果T组、TR组、P组和N组手术时间、术中出血量和术后住院时间比较差异无统计学意义(P>0.05)。TR组术后首次排气时间、术后下床活动时间明显低于T组(P<0.05),而与P组比较差异无统计学意义(P>0.05)。4组Ramsay镇静评分在组间、时点间、组间·时点间交互作用方面比较差异无统计学意义(P>0.05);4组VAS疼痛评分在组间、时点间、组间和时点间交互作用方面差异有统计学意义,随着时间的延长,4组VAS疼痛评分均呈下降趋势(P<0.05)。术后24 h,4组C反应蛋白(C reactive protein,CRP)、白细胞介素6(interleukin 6,IL-6)、皮质醇(cortisol,Cor)和E均明显优于术毕,差异有统计学意义(P<0.05)。术后24 h,T组、TR组、P组CRP、IL-6、Cor和E低于N组,TR组术后术后24 h时CRP、IL-6、Cor和E低于T组,差异无统计学意义(P<0.05),TR组与P组比较差异无统计学意义(P>0.05)。术后24 h,4组CO和SV均优于术毕,差异有统计学意义(P<0.05)。术后24 h,T组、TR组、P组CO高于N组,SV低于N组;TR组CO高于T组,SV低于T组,差异有统计学意义(P<0.05),TR组与P组比较差异无统计学意义(P>0.05)。4组简易精神状态评价量表(mini-mental state examination,MMSE)评分组间、组间和时点间交互作用比较差异无统计学意义(P>0.05),时点间比较差异有统计学意义,MMSE评分随术后时间推移而升高(P<0.05)。4组比较差异无统计学意义(P>0.05)。结论在ERAS理念下,在LC手术中应用TAPB联合RSB可有效减轻患者术后疼痛、炎症应激反应,安全性好,与术后静脉自控镇痛效果相当。
Objective To investigate the rehabilitation quality and safety of patients after different modes of nerve block under the concept of enhanced recovery(ERAS)in laparoscopic cholecystectomy(LC).Methods A total of 85 patients who underwent LC in our hospital were selected and treated with LC.According to the postoperative nerve block mode,the patients were divided into T group(n=22),TR group(n=20),P group(n=21)and N group(n=22).T Group was given right lateral costal transverse abdominal muscle plane block(TAPB),TR group was given TAPB combined with right rectus abdominis sheath block(RSB),A group was given patient-controlled intravenous analgesia(PCIA),and N group was not given analgesic intervention.The differences in duration of operation,intraoperative bleeding,Ramsay sedation score(RSS)and visual analogue scale(VAS)score in each group were observed.Results There was no significant difference in T group,TR group,P group and N group with respect to duration of operation,intraoperative bleeding and length of postoperative hospital stay(P>0.05).The time of first exhaust and the first time of off-bed activity after operation in TR group were significantly lower than those in T group(P<0.05),but there was no significant difference compared with P group(P>0.05).There was no significant difference in RSS among the four groups in terms of interaction between groups,time points,time points between groups(P>0.05).The VAS pain scores of the four groups were statistically significant in terms of interaction between groups,time points,and time points between groups.With the extension of time,the VAS pain scores of the four groups showed a downward trend(P<0.05).At 24 h after operation,C reactive protein(CRP),interleukin 6(IL-6),cortisol(Cor)and E in the four groups were significantly better than those after operation,suggesting significant differences(P<0.05).At 24 h after operation,CRP,IL-6,Cor and E in T group,TR group and P group were lower than those in N group,and CRP,IL-6,Cor and E in TR group were lower than those in T group at 24 h after operation,with no significant difference(P<0.05).There was no significant difference between TR group and P group(P>0.05).At 24 h after operation,CO and SV in the four groups were better than those after operation,and the difference was statistically significant(P<0.05).At 24 h after operation,CO in T group,TR group and P group was higher than that in N group,while SV was lower than that in N group;CO in TR group was higher than that in T group,while SV was lower than that in T group,and the difference was statistically significant(P<0.05);there was no significant difference between TR group and P group(P>0.05).There was no significant difference in the interaction between groups,time points,and time points between groups with respect to the scores of the Mini-mental State Examination(MMSE)in the four groups(P>0.05),but there was significant difference between time points.The MMSE score increased with time after surgery(P<0.05).There was no significant difference among the four groups(P>0.05).Conclusion Under the concept of ERAS,the application of TAPB combined with RSB in LC surgery can effectively reduce postoperative pain and inflammatory stress response,with good safety,which is equivalent to the effect of postoperative PCIA.
作者
张敏
张富杰
谭会领
崔同阳
武振东
吕吟啸
ZHANG Min;ZHANG Fu-jie;TAN Hui-ling;CUI Tong-yang;WU Zhen-dong;LYU Yin-xiao(Department of Anesthesiology,Hebei Petro China Central Hospital,Langfang 065000,China)
出处
《河北医科大学学报》
CAS
2023年第1期51-56,共6页
Journal of Hebei Medical University
基金
廊坊市科学技术研究与发展计划项目(2021013149)。
关键词
胆囊切除术
腹腔镜
加速康复外科
神经阻滞
cholecystectomy,laparoscopic
enhanced recovery after surgery
nerve block
