摘要
目的 探讨超声引导阻滞结合全身麻醉在肝脏切除术中的应用效果及对肝缺血再灌注损伤的影响.方法 前瞻性选取2023年1月至12月于延安市人民医院行肝脏切除术患者92例作为研究对象,按照随机数字表法分为观察组及对照组,各46例.对照组采取常规全身麻醉,观察组采取超声引导阻滞结合全身麻醉.比较两组麻醉诱导前(T0)、开始手术时(T1)、手术探查(T2)、术毕(T3)时刻的心率、平均动脉压(MAP),对比瑞芬太尼用量,恢复时间[苏醒、拔管、定向力恢复时间],术后6、12、24、48 h的视觉模拟评分法(VAS)评分,术前、术后3 d的肝功能[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)],术前、术后3 d的氧化应激反应指标[γ-谷氨酰转肽酶(γ-GGT)、丙二醛、超氧化物歧化酶(SOD)].结果 观察组T0、T,、T2、T3时心率、MAP与对照组比较,差异均无统计学意义(P＞0.05).观察组的瑞芬太尼用量为(30.40±12.10)mg,少于对照组[(40.70±12.70)mg],观察组苏醒、拔管及定向力恢复时间分别为(8.20±1.30)、(10.10±2.20)、(14.10±3.30)min,均短于对照组[(11.30±1.80)、(14.70±2.90)、(17.10±3.90)min],差异均有统计学意义(P＜0.05).术后12、24、48 h,两组的VAS分值均较术后6 h显著下降,观察组术后 6、12、24、48 h 的 VAS 分值分别为(2.42±0.56)、(2.09±0.42)、(1.89±0.44)、(1.62±0.41)分,均低于对照组[(3.61±0.82)、(3.36±0.79)、(2.32±0.77)、(1.94±0.55)分],差异均有统计学意义(P＜0.05).术后 3 d,两组的 AST、ALT、ALP 均较术前显著升高,观察组的 AST、ALT、ALP 分别为(127.42±24.17)、(462.27±53.17)、(104.58±29.76)U/L,均低于对照组[(162.59±29.74)、(529.94±61.38)、(118.79±31.27)U/L],差异均有统计学意义(P＜0.05).术后3 d,术后3 d,两组的γ-GGT、丙二醛、SOD均较术前显著升高,观察组的γ-GGT、丙二醛、SOD分别为(66.02±8.34)U/L、(16.27±3.11)μmo l/L、(86.69±13.34)U/L,均低于对照组[(70.26±10.97)U/L、(20.97±3.74)μmol/L、(95.17±14.28)U/L],差异均有统计学意义(P＜0.05).结论 在肝脏切除术中采取超声引导阻滞结合全身麻醉,能帮助患者维持较稳定的生命体征,能减少麻醉药物用量,缩短术后恢复时间,减轻术后疼痛,减小肝缺血再灌注损伤.
Abstract
Objective To investigate the application of ultrasound-guided block combined with general anesthesia in liver resection and its effect on hepatic ischemia-reperfusion injury.Methods A total of 92 patients who underwent hepatectomy in Yan'an People's Hospital from January 2023 to December 2023 were prospectively selected as the study objects and divided into the observation group and the control group ac-cording to random number table method,with 46 cases each.The control group received general anesthesia,and the observation group received ul-trasound-guided block combined with general anesthesia.The heart rate and mean arterial pressure(MAP)of the two groups were compared be-fore anesthesia induction(T0),at the beginning of surgery(T1),surgical exploration(T2),and after surgery(T3).The dosage of remifentanil was compared,the recovery time[awakening,extubation,and orientation recovery time],and the visual simulation score(V AS)of 6,12,24 and 48 h after surgery.Liver function[(aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP)]before and 3 d after surgery,Oxidative stress response indicators[(gamma glutamyl transpeptidase(γ-GGT),malondialdehyde,superoxide dismutase(SOD)]before and 3 d after surgery of the two groups were compared.Results Heart rate and MAP of T0,T1,T2 and T3 in the observation group were not significantly different from those in the control group(P＞0.05).The dosage of remifentanil in the observation group was(30.40±12.10)mg,which was less than that in the control group[(40.70±12.70)mg],the recovery time,extubation time and orientation recovery time in the observation group were(8.20±1.30),(10.10±2.20),(14.10±3.30)min,which were shorter than those in the control group[(11.30±1.80),(14.70±2.90),(17.10±3.90)min],the differences were statistically significant(P＜0.05).At 12,24 and 48 h after operation,the VAS scores of the two groups were significantly lower than those at 6 h after operation,the VAS scores of the observation group at 6,12,24 and 48 h after operation were(2.42±0.56),(2.09±0.42),(1.89±0.44)and(1.62±0.41)points,respectively,which were lower than those of the control group[(3.61±0.82),(3.36±0.79),(2.32±0.77)and(1.94±0.55)points],the differences were statistically significant(P＜0.05).At 3 d after operation,the AST,ALT and ALP of the two groups were significantly higher than those before operation.The AST,ALT and ALP of the observation group were(127.42±24.17),(462.27±53.17)and(104.58±29.76)U/L,respectively,which were lower than those of the control group[(162.59±29.74),(529.94±61.38)and(118.79±31.27)U/L],the differences were statistical-ly significant(P＜0.05).At 3d after operation and 3 d after operation,the levels of y-GGT,malondialdehyde and SOD in the two groups were significantly higher than those before operation.The levels of y-GGT,malondialdehyde and SOD in the observation group were(66.02±8.34)U/L,(16.27±3.11)μmol/L and(86.69±13.34)U/L,which were lower than those in the control group[(70.26±10.97)U/L,(20.97±3.74)μmol/L,(95.17±14.28)U/L],the differences were statistically significant(P＜0.05).Conclusion Ultrasound-guided block combined with general anesthesia can help patients maintain stable vital signs,reduce the dosage of anesthetic drugs,shorten postoperative recovery time,alleviate postoperative pain,and reduce hepatic ischemia-reperfusion injury during hepatectomy.
维普
万方数据