腹横筋膜阻滞对肝癌手术患者术后疼痛及肝肾功能的影响

Effect of Transverse Abdominal Fascia Block on Postoperative Pain,Liver and Kidney Function in Patients with Hepatocellular Carcinoma

【目的】探讨腹横筋膜阻滞对肝癌手术患者术后疼痛以及肝肾功能的影响。【方法】选取2017年7月至2020年7月在本院接受手术治疗的肝癌患者90例,采用随机数表法分为观察组(n=45)和对照组(n=45)。对照组给予静吸复合全身麻醉,观察组给予腹橫筋膜阻滞。比较两组患者治疗后不同时间点视觉模拟评分(VAS)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、血尿素氮(BUN)、血肌酐(SCr)变化;记录治疗期间患者肝功不全、腹水、切口不愈等并发症发生率。【结果】观察组患者术后4 h、8 h、12 h、24 h时VAS评分均低于对照组,差异有统计学意义(P<0.05);术后即刻两组患者CRP、TNF-α、IL-6表达水平均高于术前;观察组术后4 h、24 h时CRP、TNF-α、IL-6表达水平均低于对照组;术后即刻、术后4 h、24 h两组患者AST、ALT表达水平均高于术前,且观察组低于对照组,其差异均有统计学意义(P<0.05);两组患者术后各时间点ALB表达水平无明显变化(P>0.05)。术后即刻、术后4 h、术后24 h两组患者BUN、SCr均表现为升高后降低,且观察组表达水平均低于对照组(P<0.05)。治疗期间,观察组出现肝功不全、腹水、切口不愈等并发症的总发生率低于对照组(6.67% vs 26.67%),差异有显著性(P<0.05)。【结论】腹横筋膜阻滞用于肝癌手术患者镇痛效果显著,可降低炎性细胞因子水平,保护患者肝、肾功能,利于患者术后快速康复。

【Objective】To investigate the effect of transverse abdominal fascia block on postoperative pain and liver and kidney function in patients with liver cancer.【Methods】A total of 90 patients with liver cancer who received surgical treatment in our hospital from July 2017 to July 2020 were selected and randomly divided into observation group(n=45)and control group(n=45).The control group was given rest combined with general anesthesia,and the observation group was given transverse abdominal fascia block.Visual analogue scale(VAS),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α),Interleukin-6(IL-6),aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),blood urea nitrogen(BUN)and serum creatinine(SCR)were measured and compared between the two groups at different time points after treatment;The incidence of liver insufficiency,ascites,and wound healing were recorded.【Results】The VAS scores at 4 h,8 h,12 h and 24 h after operation in the observation group were lower than those in the control group(P<0.05);The levels of CRP and TNF-α and IL-6 in the two groups immediately after operation were higher than those before operation;The levels of CRP,TNF-α and IL-6 at 4 h and 24 h after operation in the observation group were significantly lower than those in the control group.The expression levels of AST and ALT in the two groups immediately after operation,4 h and 24 h after operation were higher than those before operation,and the observation group was lower than the control group,the differences were statistically significant(P<0.05);There was no significant difference in ALB expression between the two groups at each time point(P>0.05).BUN and SCr were increased and then decreased in the two groups immediately after operation,4 h after operation and 24 h after operation,and the expression level in the observation group was lower than that in the control group(P<0.05).During the treatment,the total incidence of liver insufficiency,ascites,wound healing and other complications in the observation group was lower than that in the control group(6.67% vs 26.67%),the difference was significant(P〈0.05).[Conclusion]Transverse abdominal fas-cia block has significant analgesic effect in patients with liver cancer surgery,which can reduce the level of inflammatory cytokines,protect the liver and kidney function of patients»and is conducive to the rapid recovery of patients after surgery.