摘要
目的探讨以区域阻滞为基础的多模式镇痛对肝癌开腹手术患者术后康复的影响。方法选取西安交通大学第一附属医院2019年6月至2020年5月择期行肝癌开腹手术的患者80例为研究对象,将患者随机分为区域阻滞组(R组)和对照组(C组)。比较两组患者的苏醒时间,苏醒即刻和术后24、48 h的数字模拟疼痛评分(NRS评分),镇痛药用量和术后恶心呕吐的发生率,术后血浆TNF-α、IL-6和肝功能指标的变化,术后恢复质量Qo R-15评分,术后住院时间。结果R组患者的苏醒时间较C组显著缩短(P>0.01),苏醒即刻和术后24 h内的NRS评分显著低于C组(均P<0.05);R组术后镇痛药的使用量显著低于C组(P<0.01),术后24 h恶心呕吐的发生率低于C组(P<0.05);R组术后T1、T2时间点上TNF-α和IL-6水平明显低于C组(P<0.05);R组患者术后谷丙转氨酶、总胆红素和白蛋白水平低于C组(P<0.05),Qo R-15评分高于C组(P<0.05),术后住院时间缩短(P<0.05)。结论全麻复合以区域阻滞为基础的多模式镇痛方案能够完善镇痛效果,减少不良反应,并有效抑制炎性因子,改善肝癌开腹手术患者的术后早期镇痛状况,减少住院时间,值得在临床推广应用。
Objective To investigate the effect of multimodal analgesia based on regional block on postoperative rehabilitation in liver cancer patients with undergoing laparotomy.Methods From June 2019 to May 2020,80 patients undergoing laparotomy for liver cancer in our hospital were selected.The patients were randomly divided into regional block group(group R)and control group(group C).The time of awakening and the digital analog pain score(NRS score),the dosage of analgesics and the incidence of postoperative nausea and vomiting(PONV)were compared between the two groups at the moment of awakening,24 h and 48 h after operation.The changes of plasma TNF-α,IL-6 and liver function index,QoR-15 score of postoperative recovery quality and postoperative hospital stay were recorded.Results The time of awakening in group R was significantly shorter than that in group C(P>0.01),and the NRS score immediately after awakening and within 24 h after operation in group R was significantly lower than that in group C(all P<0.05).The use of postoperative analgesics in group R was significantly lower than that in group C,and the incidence of PONV at 24 h after operation in group R was significantly lower than that in group C(P<0.05).The levels of TNF-an and IL-6 at T1 and T2 in group R were significantly lower than those in group C(P<0.05).The levels of ALT,TBIL and ALB in group R were lower than those in group C,and the QoR-15 score was higher than that in group C.the postoperative hospital stay in group R was shorter than that in group C(P<0.05).Conclusion The multimode analgesia scheme of general anesthesia combined with regional block could improve the analgesic effect,reduce adverse reactions,effectively inhibit inflammatory factors,improve early analgesic effect of patients with liver cancer after laparotomy,and reduce hospital stay,which is worthy of clinical application.
作者
王韶双
周艳楠
阳婷婷
严军
董麦娟
王强
WANG Shaoshuang;ZHOU Yannan;YANG Tingting;YAN Jun;DONG Maijuan;WANG Qiang(Department of Anesthesiology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)
出处
《实用医学杂志》
CAS
北大核心
2021年第15期1939-1943,共5页
The Journal of Practical Medicine
基金
国家自然科学基金项目(编号:81974540)
陕西省中医药管理局项目(编号:zyjzdyjs-16)
院级临床研究计划项目(编号:XJYFY-2019W9)。
关键词
全身麻醉
区域阻滞
多模式镇痛
肝癌
术后康复
general anesthesia
regional block
multimodal analgesia
liver cancer
postoperative rehabilitation
作者简介
通信作者:王强,E⁃mail:dr.wangqiang@139.com。
