|
| 布比卡因脂质体用于腹外斜肌-肋间肌平面阻滞对肝部分切除术患者术后早期恢复质量的影响 |
| Effect of liposomal bupivacaine administered in external oblique intercostal block on quality of early postoperative recovery in patients undergoing partial hepatectomy |
| |
| DOI：10.12089/jca.2026.06.005 |
| 中文关键词: 布比卡因脂质体 腹外斜肌-肋间肌平面阻滞 肝部分切除术 恢复质量 |
| 英文关键词: Liposomal bupivacaine External oblique intercostal block Partial hepatectomy Recovery quality |
| 基金项目:南昌大学第一附属医院临床研究培育项目（YFYLCYJPY202541） |
|
| 摘要点击次数: 445 |
| 全文下载次数: 54 |
| 中文摘要: |
目的：探讨布比卡因脂质体用于腹外斜肌-肋间肌平面阻滞（EOIB）对肝部分切除术患者术后早期恢复质量的影响。
方法：选择全麻下择期行肝部分切除术的患者，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：布比卡因脂质体组（B组）和罗哌卡因组（L组）。两组于全麻气管插管后行双侧EOIB，B组采用0.665%布比卡因脂质体20 ml（含布比卡因脂质体133 mg）；L组采用0.375%罗哌卡因20 ml（含罗哌卡因75 mg）。主要指标为术后72 h QoR-15评分。次要指标包括术前24 h、术后24、48 h QoR-15评分，麻醉诱导前、手术切皮时、手术开始后1 h HR和MAP，术后4、8、12、24、48、72 h静息和咳嗽时NRS疼痛评分，术后72 h内舒芬太尼用量，镇痛泵首次按压时间、镇痛泵有效按压次数，首次补救镇痛时间及补救镇痛率，术后首次肛门排气时间、术后首次下床活动时间、术后住院时间。不良反应包括术后72 h内头晕、恶心呕吐以及阻滞完成至出院期间血气胸、穿刺部位组织或神经损伤、局麻药全身毒性反应等。
结果：共纳入患者60例，每组30例。与L组比较，B组术后24、48、72 h QoR-15评分明显升高，手术切皮时HR明显增快，MAP明显升高，术后12、24、48、72 h静息和咳嗽时NRS疼痛评分明显降低，术后72 h内舒芬太尼用量明显减少，镇痛泵首次按压时间明显延长，镇痛泵有效按压次数明显减少，补救镇痛率明显降低，术后首次肛门排气时间、术后首次下床活动时间均明显缩短，不良反应发生率明显降低（P<0.05）。两组均无血气胸、穿刺部位组织或神经损伤、局麻药全身毒性反应等不良反应发生。
结论： 肝部分切除术患者术中采用超声引导下0.665%布比卡因脂质体行EOIB的镇痛效果确切，可延长术后镇痛时间，减少术后镇痛药物用量，有利于提升患者术后早期恢复质量。 |
| 英文摘要: |
Objective: To investigate the effect of liposomal bupivacaine administered in external oblique intercostal block (EOIB) on quality of early postoperative recovery in patients undergoing partial hepatectomy.
Methods: Patients scheduled for elective partial hepatectomy under general anesthesia were selected, aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ. The patients were randomly divided into two groups using a random number table: liposomal bupivacaine group (group B) and ropivacaine group (group L). After general anesthesia with endotracheal intubation, bilateral EOIB was performed in both groups. Group B received 0.665% liposomal bupivacaine 20 ml (containing bupivacaine liposome 133 mg), while group L received 0.375% ropivacaine 20 ml (containing ropivacaine 75 mg). The primary outcome was QoR-15 score at 72 hours postoperatively. Secondary outcomes included QoR-15 scores at 24 preoperatively, 24 and 48 hours postoperatively, HR and MAP before anesthesia induction, at skin incision, and at 1 hour postoperatively, numeric rating scale (NRS) scores at rest and during coughing at 4, 8, 12, 24, 48, and 72 hours postoperatively, the dosage of sufentanil consumption within 72 hours postoperatively, the first pressing time of the analgesic pump, the number of effective pressing of the analgesic pump, the time of the first rescue analgesia and the rescue analgesia rate, the time of the first postoperative rectal exhaust, the time of the first postoperative ambulation, and the postoperative hospital stay. Adverse reactions included dizziness, adverse reactions within 72 hours postoperatively, as well as pneumothorax, tissue damage at the puncture site, nerve injury, and systemic toxic reactions of local anesthetics during the period from the completion of block to discharge.
Results: A total of 60 patients were included, with 30 patients in each group. Compared with group L, the QoR-15 scores of group B at 24, 48, and 72 hours postoperatively were significantly higher, the HR during skin incision was significantly increased, MAP was significantly increased, the NRS pain scores at rest and during coughing were significantly lower at 12, 24, 48, and 72 hours postoperatively, the cumulative fentanyl dosage within 72 hours postoperatively was significantly reduced, the first press time of the analgesic pump was significantly prolonged, the effective press times of the analgesic pump were significantly reduced, the rescue analgesia rate was significantly lower, the first time of anal transit and the first time of getting out of bed after surgery were significantly shortened, and the incidence of adverse reactions was significantly lower (P < 0.05). No adverse reactions such as hemopneumothorax, tissue or nerve injury at the puncture site, or systemic toxic reactions of local anesthetics occurred in both groups.
Conclusion: Ultrasound-guided EOIB with 0.665% liposomal bupivacaine provides definitive analgesic efficacy in patients undergoing partial hepatectomy, with a significantly prolonged duration of action. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
