喉罩全麻下镇痛方式对超声引导经皮肝癌射频治疗患者术后康复的影响

Effect of multimodal analgesia under laryngeal mask general anesthesia on postoperative rehabilitation of patients with ultrasound guided percutaneous radiofrequency therapy for liver cancer

目的:探讨喉罩通气全身麻醉下,不同镇痛方式对超声引导经皮肝癌射频治疗患者术后康复的影响。方法:选取我院2018年11月至2019年5月择期在超声引导下行经皮肝癌射频消融治疗术的患者120例为研究对象。将患者随机分为多模式镇痛组(F组)和阿片药物镇痛组(S组)。对比两组苏醒时间和苏醒即刻疼痛VAS评分;术后第1 d、2 d镇痛药的需求次数和恶心、呕吐的发生率;术后血浆TNF-α和IL-6的变化以及术后2天肝功能的变化。结果:两组苏醒时间无显著性差异(P>0.05);F组苏醒即刻疼痛VAS评分明显低于S组(P<0.05)。F组术后第1 d和第2 d镇痛药的需求次数和恶心、呕吐的发生率明显低于S组(P<0.05)。F组术后T1、T2、T3时间点上TNF-α和IL-6水平明显低于S组(P<0.05)。F组术后48 h(T4)时肝功能ALT、TBIL指标水平明显低于S组(P<0.05)。结论:对于超声引导下经皮肝癌射频治疗的患者,应用氟比洛芬酯和局部浸润联合舒芬太尼的多模式镇痛能够降低不良反应发生率,并有效抑制炎性因子,改善患者术后肝功能,镇痛效果显著,值得临床推广应用。

Objective:To explore the effect of different analgesic methods on patients undergoing ultrasound guided percutaneous radiofrequency ablation for hepatocellular carcinoma.Methods:From November 2018 to May 2019,120 patients undergoing ultrasound guided percutaneous radiofrequency ablation for hepatocellular carcinoma were selected.The patients were randomly assigned to the multimodal analgesia group(F group)and the opioids analgesia group(S group).Awaking time and the VAS score of the patient immediately after waking up were recorded.The number of requirements for the analgesic drug in the 1 d,2 d after surgery and the incidence of nausea and vomiting were recorded.The changes of TNF-α and IL-6 in the serum and the changes of liver function in two days after surgery were recorded.Results:There was no significant difference in awaking time between the two groups(P>0.05).The VAS score in the F group was significantly lower than in the S group(P<0.05).The frequency and incidence of nausea and vomiting in the F group were significantly lower than those in group S(P<0.05).TNF-αand IL-6 in the F group was significantly lower than those in S group(P<0.05)at T1,T2,T3.The levels of ALT and TBIL were significantly lower in the F group than those in the S group(P<0.05)at 48 h(T4).Conclusion:As for the ultrasound guided percutaneous radiofrequency ablation for liver cancer,multimodal analgesia methods can reduce the incidence of adverse reactions,effectively restrain the inflammatory factor,improve postoperative liver function of patients.Multimodal analgesia methods provide more satisfactory analgesic effect,worthy of popularization and application.