肝癌腹腔镜根治术后PCIA并胸椎旁神经阻滞的效果

Efficacy of patient-controlled intravenous analgesia combined with thoracic paravertebral nerve block after laparoscopic radical resection for liver cancer

目的探讨肝癌腹腔镜根治术后静脉自控镇痛(PCIA)并胸椎旁神经阻滞的效果。方法选取2021年3月—2023年2月河北省沧州中西医结合医院行腹腔镜肝癌根治术治疗的84例病人,随机分为观察组与对照组,每组42例。对照组采用常规阿片类药物静脉镇痛,观察组采用PCIA并胸椎旁神经阻滞镇痛。比较两组术后疼痛程度、Ramsay镇静评分、炎症因子、肝功能及不良反应等指标。结果观察组术后12、24、72h静息状态下疼痛评分及Ramsay镇静评分均显著低于对照组(F=2.930~13.850,P<0.05)。观察组术后72h肿瘤坏死因子-α、白细胞介素-6和降钙素原水平均显著低于对照组(F=6.139~8.961,P<0.05)。观察组术后72h谷草转氨酶、总胆红素和谷丙转氨酶水平均显著低于对照组(F=3.845~5.216,P<0.05)。观察组不良反应总发生率(7.14%)虽低于对照组(14.29%),但两组差异无统计学意义(χ^(2)=1.120,P>0.05)。结论肝癌腹腔镜根治术后应用PCIA并胸椎旁神经阻滞能显著提升镇痛和镇静效果,减轻炎症反应,降低肝功能损伤,值得临床推广应用。

Objective To investigate the efficacy of patient-controlled intravenous analgesia(PCIA)combined with thoracic paravertebral nerve block after laparoscopic radical resection for liver cancer.Methods A total of 84 patients who underwent laparoscopic radical resection for liver cancer in Cangzhou Integrated Traditional Chinese and Western Medical Hospital from March 2021 to February 2023 were enrolled and randomly divided into observation group and control group,with 42 patients in each group.The patients in the control group received routine intravenous opioid analgesia,while those in the observation group received PCIA combined with thoracic paravertebral nerve block.The two groups were compared in terms of postoperative pain,Ramsay sedation score,inflammatory factors,liver function,and adverse reactions.Results Compared with the control group,the observation group had significantly lower pain score and Ramsay sedation score at rest at 12,24,and 72 hours after surgery(F=2.930-13.850,P<0.05).Compared with the control group at 72 hours after surgery,the observation group had significantly lower levels of tumor necrosis factor-α,interleukin-6,and procalcitonin than the control group(F=6.139-8.961,P<0.05),as well as significantly lower levels of aspartate aminotransferase,total bilirubin,and alanine aminotransferase(F=3.845-5.216,P<0.05).Although the observation group had a lower overall incidence rate of adverse reactions than the control group,there was no significant difference between the two groups(7.14%vs 14.29%,χ^(2)=1.120,P>0.05).Conclusion PCIA combined with thoracic paravertebral nerve block after laparoscopic radical resection for liver cancer can significantly improve analgesic and sedative effects,alleviate inflammatory response,and mitigate liver impairment,and therefore,it holds promise for clinical application.