超声引导下低位前锯肌平面和腹直肌鞘阻滞对肝叶切除术后疼痛、应激及早期康复的影响

Effect of ultrasound guided low anterior serratus plane and rectus abdominis sheath block on postoperative pain,stress and early rehabilitation after open hepatectomy

目的探讨超声引导下低位前锯肌平面和腹直肌鞘阻滞对开腹肝叶切除术后疼痛、应激及早期康复的影响。方法选择2020年10月至2022年9月在广元市中心医院拟在开腹下行肝叶切除术的患者80例,随机数字表法分为对照组(C组)和试验组(R组),每组40例。C组患者予以全身麻醉进行开腹肝叶切除术;R组患者麻醉诱导前在超声引导下行低位前锯肌平面和腹直肌鞘阻滞+全身麻醉下开腹肝叶切除术。于麻醉前(T_(0))、切皮后(T_(1))、手术开始后1h(T_(2))、术毕(T_(3))、术后6h(T_(4))、术后24h(T_(5))评估患者静止及动态疼痛及镇痛满意度;于不同时间点检测血糖水平(Glu)、血浆皮质醇(Cor)浓度及生命体征;评价患者的术后恢复质量以及并发症发生情况。结果与C组比较,R组患者术后T_(4)及T_(5)时间点静止及动态疼痛降低(P<0.05),镇痛补救更少(P<0.05),镇痛满意度增加(P<0.05)。与C组比较,R组患者麻醉手术过程中T_(1)~T_(4)时Glu、Cor水平及生命体征更加平稳(P<0.05)。与C组比较,R组患者术后恢复质量更高(P<0.05)。结论超声引导下低位前锯肌平面和腹直肌鞘阻滞能减少开腹肝叶切除术患者术后疼痛、应激,可以促进患者术后早期康复,并降低术后并发症的发生,是一种有效的麻醉辅助方案。

Objective To investigate the effect of ultrasound guided low anterior serratus plane and rectus abdominis sheath block on pain,stress and early rehabilitation after open hepatectomy.Methods From October 2020 to September 2022,80 patients in Guangyuan Central Hospital who planned to undergo hepatectomy under laparotomy were selected and randomly divided into the control group(Group C)and the test group(Group R),with 40 patients in each group.Patients in group C were given general anesthesia for open hepatectomy.Before induction of anesthesia,patients in group R underwent open hepatectomy under ultrasound guided low ante-rior serratus plane and rectus abdominis sheath block+general anesthesia.Before anesthesia(T_(0)),after sKin incision(T_(1)),1h after op-eration(T_(2)),after the operation(T_(3)),6h after operation(T_(4)),24h after operation(T_(5)),patients′static and dynamic pain and pain relief satisfaction were evaluated.Blood glucose level,plasma cortisol(Cor)concentration and vital signs were measured at different time points.The quality of postoperative recovery and complications were evaluated.Results Compared with group C,patients in group R had lower static and dynamic pain at T_(4)-T_(5)after surgery(P<0.05),less pain relief(P<0.05),and increased satisfaction with pain re-lief(P<0.05).In addition,compared with group C,the blood glucose,plasma cortisol(Cor)concentration and vital signs of patients in group R at different time points during anesthesia and surgery were more stable at T_(1)-T_(4)(P<0.05).Finally,compared with group C,the quality of postoperative recovery in group R was higher(P<0.05),and there was no increase in complications(P>0.05).Conclu-sion Ultrasound guided low anterior serratus plane and rectus abdominis sheath block could reduce postoperative pain and stress in pa-tients undergoing open hepatectomy,improve early postoperative recovery,and did not increase postoperative complications,which was an effective anesthetic auxiliary scheme.