超声引导下腹横肌平面阻滞联合喉罩通气在原发性肝癌患者加速康复外科中的有效性和安全性

The effectiveness and safety of ultrasound-guided transversus abdominis plane block combined with laryngeal mask ventilation general anesthesia in enhanced recovery after surgery for patients with primary liver cancer

目的 探计超声引导下腹横肌平面(TAP)阻滞联合喉罩通气在原发性肝癌患者加速康复外科中的有效性和安全性。方法 选择2018年6月至2020年11月成都中医药大学附属医院行腹腔镜肝切除术治疗的患者189例,根据麻醉方法不同分为观察组96例和对照组93例。观察组行超声引导下TAP阻滞联合全身麻醉喉罩通气,对照组行单纯气管内插管全麻,记录术后总住院时间、术后48 h内的镇痛需求、首次排气时间、麻醉药物及血管活性药物消耗量等术中一般情况。记录麻醉诱导前(T0)、手术开始(T1)、手术结束(T2)和离开手术室时(T3)的血糖和乳酸水平;采用40项恢复质量评分量表(QoR-40)及数字评定量表(NRS)评价两组患者早期恢复质量及手术切口疼痛情况,并记录不良反应情况。结果观察组术后住院时间、首次下床时间、出血量、术后舒芬太尼消耗量、首次排气时间、输液量、七氟烷、瑞芬太尼、罗库溴铵、多巴酚丁胺与去甲肾上腺素消耗量与对照组相比明显降低(均P<0.05)。观察组T1及T2时血糖水平明显低于对照组,T2及T3时血清乳酸水平明显低于对照组(均P<0.05)。观察组术后2、6、24和48 h时,NRS评分均明显低于对照组(均P<0.05);而术后1 d和3 d时,QoR-40评分均明显高于对照组(均P<0.05)。2组患者均有多种不良反应出现,但发生率差异均无统计学意义(均P>0.05)。结论超声引导下TAP阻滞联合喉罩通气在原发性肝癌患者围手术期有良好的镇痛效果,安全性高,且可减少术中、术后镇痛药物的使用,有利于快速康复。

ObjectiveTo explore the effectiveness and safety of ultrasound-guided transversus abdominis plane(TAP)block combined with laryngeal mask ventilation general anesthesia in enhanced recovery after surgery(ERAS)for patients with primary hepatocellular carcinoma(HCC).MethodsA total of 189 patients with primary HCC,who underwent laparoscopic hepatectomy at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine of China between June 2018 and November 2020,were enrolled in this study.According to the used anesthesia method,the patients were divided into study group(n=96)and control group(n=93).TAP block combined with laryngeal mask ventilation general anesthesia was employed for the patients of the study group,while pure endotracheal intubation general anesthesia was adopted for the patients of the control group.The postoperative hospitalization time,postoperative need of analgesic drugs within 48 hours,postoperative first exhaust time,consumption of anesthetic drug and vascular active drug,etc.were recorded.Blood glucose and lactate levels were determined at the following time points:before anesthesia induction(T0),starting operation(T1),end of the operation(T2)and leaving operating room(T3).By using 40-quality items of restore scale(QoR-40)score and numerical rating scale(NRS)score,the quality of early recovery and surgical incision pain were evaluated in both groups,and the adverse reactions were recorded.ResultsThe postoperative hospitalization time,first time to get out of bed,amount of blood loss,postoperative sufentanil consumption,first exhaust time,infusion volume,and consumption amount of sevoflurane,remifentanil,rocuronium,dobutamine and norepinephrine in the study group were significantly lower than those in the control group(all P<0.05).The postoperative 2-,6-,24-,and 48-hour NRS scores in the study group were obviously lower than those in the control group(all P<0.05).The postoperative 1-day and 3-day QoR-40 scores in the study group were remarkably lower than those in the control group(both P<0.05).A variety of adverse reactions occurred in both groups,but there was no significant difference between the two groups(all P>0.05).ConclusionUltrasound-guided TAP block combined with laryngeal mask ventilation general anesthesia has a good analgesic effect for HCC patients during perioperative period with high safety.It can reduce the use of intraoperative and postoperative analgesic drugs and help achieve a quick recovery.