文章摘要
多模式镇痛对经腹肝部分切除术患者术后恢复质量的影响
Effect of multimodal analgesia on quality of recovery in patients undergoing trans-abdominal partial hepatectomy
  
DOI：10.12089/jca.2021.06.012
中文关键词: 肝部分切除术  多模式镇痛  恢复质量  帕瑞昔布钠
英文关键词: Partial hepatectomy  Mutimodal analgesia  Quality of recovery  Parecoxib sodium
基金项目:安徽省科技计划项目（1704a0802150）
作者单位E-mail
檀梦媛 241002,安徽省芜湖市,皖南医学院研究生学院  
乔晓斐 中国科学技术大学附属第一医院（安徽省立医院）肝脏外科  
高晨 中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
章敏 中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
栾远航 中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
荚卫东 中国科学技术大学附属第一医院（安徽省立医院）肝脏外科  
谢言虎 中国科学技术大学附属第一医院（安徽省立医院）麻醉科 xyh200701@sina.cn 
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中文摘要:
      
目的 评价多模式镇痛方案对经腹肝部分切除术患者术后恢复质量的影响。
方法 选取经腹肝部分切除术患者110例，男84例，女26例，年龄18～75岁，BMI 18.0～25.0 kg/m2，ASA Ⅱ或Ⅲ级。随机分为两组：多模式镇痛组（M组）和对照组（C组），每组55例。M组在诱导前30 min静脉注射帕瑞昔布钠40 mg，术毕在超声引导下以0.375%罗哌卡因20 ml行术侧腹横肌平面阻滞（TAPB），术后静脉注射帕瑞昔布钠40 mg，每天两次，持续3 d。术毕两组均静脉注射羟考酮5 mg，连接舒芬太尼静脉镇痛泵。记录术后2、6、12、24、48、72 h的NRS评分，记录术后首次下床时间、首次排气时间、补救镇痛例数。于术前1 d、术后1、3 d以及术后30 d采用恢复质量评分量表（QoR-40）评估患者恢复质量。记录术后恶心呕吐、瘙痒、呼吸抑制、低血压等不良反应的发生情况。
结果 与C组比较，M组术后72 h的NRS评分明显降低（P<0.05），补救镇痛次数明显减少（P<0.05），术后首次下床时间、首次排气时间明显缩短，恶心呕吐发生率明显降低（P<0.05），术后1、3 d QoR-40评分明显降低（P<0.05）。
结论 在经腹肝部分切除术患者中，采用术前非甾体抗炎药预防性镇痛、术毕腹横肌平面阻滞及术后非甾体抗炎药持续镇痛治疗的多模式镇痛方案效果良好，可加速患者康复进程，提高患者术后恢复质量。
英文摘要:
      
Objective To investigate the effect of multimodal analgesia on quality of recovery in patients with hepatocellular carcinoma (HCC) undergoing trans-abdominal partial hepatectomy.
Methods A total of 110 patients with HCC underwent patial hepatectomy, 84 males and 26 females, aged 18-75 years, BMI 18.0-25.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomized into a multimodal analgesia group (group M) and a control group (group C), 55 patients in each group. In group M, all patients were injected 40 mg parecoxib sodium intravenously 30 minutes before anesthesia induction and received ultrasound-guided transversus abdominis plane block (TAPB) using 0.375% ropivacaine 20 ml at the end of the surgery. Postoperatively, a dose of 40 mg parecoxib sodium was intravenously injected twice daily for three days. The patients in the control group didnt receive the treatment mentioned above. Patients controlled intravenous analgesia (PCIA) and intravenous administration of oxycodone 5 mg after surgery were used in all patients. The postoperative NRS scores at 2, 6, 12, 24, 48, and 72 hours, first time of off-bed activity and intestinal exhaust, number of rescue analgesia were recorded. The QoR-40 score scale was used to assess the recovery quality of patients respectively on day 1 preoperatively, and day 1, 3, 30 postoperatively. The adverse reactions of postoperative nausea and vomiting, itching, respiratory depression, and hypotension were recorded.
Results Compared with group C, NRS scores 2, 6, 12, 24, 48, and 72 hours after the surgery were lower in group M (P < 0.05). A lower risk of rescue analgesia was also reported in patients in group M (P < 0.05). The first time of off-bed activity, intestinal exhaust and the incidence of nausea and vomiting were significantly reduced (P < 0.05). QoR-40 scores were significantly lower in M group than in group C on the 1st and 3rd postoperative days (P < 0.05).
Conclusion The multimodal analgesia which uses non-steroidal anti-inflammatory drugs (NSAIDs) preoperatively for prophylactic analgesia, postoperative TAPB and NSAIDs for continuous analgesia treatment can accelerate the rehabilitation process of patients and improve the postoperative recovery quality of patients undergoing trans-abdominal partial hepatectomy.
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