术中超声引导下罗哌卡因星状神经节阻滞在腹腔镜规则性肝切除术中的应用价值

Application of intraoperative ultrasound-guided ropivacaine stellate ganglion block in laparoscopic regular hepatectomy

目的探讨术中超声引导下罗哌卡因星状神经节阻滞在腹腔镜规则性肝切除术中的应用价值。方法选取2017年3月至2019年6月在衢州市人民医院行腹腔镜规则性肝切除术的患者90例,采用随机数字表法分为观察组和对照组,每组45例。观察组于C6横突前结节根部注射0.5%罗哌卡因10 ml,对照组给予等量的0.9%氯化钠注射液。观察两组患者气管插管前(T0)、气管插管后即刻(T1)、建立气腹后即刻(T2)、肝切除后即刻(T3)、拔管后即刻(T4)等时间点心率(HR)及平均动脉压(MAP);分别于术后2、6、12和24 h采用视觉模拟评分(VAS)评估患者术后疼痛程度;分别于术前1 d和术后1、3、7 d采用简易智能精神状态量表(MMSE)评估患者的认知功能,统计两组患者术后认知功能障碍(POCD)的发生率。结果观察组患者T1~T4时间点HR均低于对照组,T2~T3时间点MAP水平均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后不同时间点VAS评分均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后1、3、7 d MMSE评分均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者POCD发生率为8.89%,低于对照组的24.44%,差异有统计学意义(P<0.05)。结论罗哌卡因星状神经节阻滞有助于维持腹腔镜规则性肝切除术患者血流动力学的相对稳定,降低术后疼痛程度,减少术后POCD的发生。

Objective To evaluate the application of ultrasound-guided stellate ganglion block with ropivacaine in laparoscopic regular hepatectomy.Methods Ninety patients with liver cancer undergoing laparoscopic regular hepatectomy in Quzhou People's Hospital from March 2017 to June 2019 were analyzed retrospectively.Patients were randomly assigned into two groups with 45 cases in each group,patients in trial group were injected with 10 ml of 0.5%ropivacaine into the root of the C6 transverse process nodule,and those in the control group were given the same amount of 0.9%sodium chloride injection.HR and MAP were measured before intubation(T0),immediately after intubation(T1),immediately after establishment of pneumoperitoneum(T2),immediately after hepatectomy(T3),and immediately after extubation(T4).The visual analogue score(VAS)at 2,6,12 and 24 h after operation were analyzed.The patients were assessed by MMSE before and after operation,and the occurrence of postoperative cognitive dysfunction(POCD)was recorded.Results The HR in the trial group was lower than that in the control group at T1-T4 time points(all P<0.05),MAP in the trial group was higher than that in the control group at T2-T3 time points(both P<0.05).VAS score in the trial group at different time points after operation was lower than that in the control group(all P<0.05).The MMSE scores of the trial group at 1,3 and 7 d after operation were higher than that in the control group(all P<0.05).The incidence of POCD in trial group was lower than that of the control group(8.89%vs 24.44%,P<0.05).Conclusion Ropivacaine stellate ganglion block helps to maintain the relative stability of hemodynamics,reduce postoperative pain,and reduce postoperative cognitive dysfunction in patients undergoing laparoscopic regular hepatectomy.