Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (1): 15-22.doi: 10.24920/003934

• 论著 • 上一篇    下一篇

超声引导下连续胸椎旁阻滞提高开腹肝切除术后患者的恢复质量:一项随机、双盲、安慰剂对照试验

崔旭蕾1,许楠1,张志永1,朱波1,张越伦2,郑永昌3,杜顺达3,毛一雷3,桑新亭3,黄宇光1,*()   

  1. 1中国医学科学院北京协和医学院北京协和医院麻醉科,北京 100730,中国
    2中国医学科学院北京协和医院北京协和医院中心实验室,北京 100730,中国
    3中国医学科学院北京协和医学院北京协和医院肝脏外科,北京 100730,中国
  • 收稿日期:2021-05-14 接受日期:2021-09-28 出版日期:2022-03-31 发布日期:2022-03-03
  • 通讯作者: 黄宇光 E-mail:garypumch@163.com

Ultrasound-Guided Continuous Thoracic Paravertebral Block Improves Patientʼs Quality of Recovery After Open Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial

Xulei Cui1,Nan Xu1,Zhiyong Zhang1,Bo Zhu1,Yuelun Zhang2,Yongchang Zheng3,Shunda Du3,Yilei Mao3,Xinting Sang3,Yuguang Huang1,*()   

  1. 1Anesthesiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    3Hepatobiliary Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2021-05-14 Accepted:2021-09-28 Published:2022-03-31 Online:2022-03-03
  • Contact: Yuguang Huang E-mail:garypumch@163.com

摘要:

背景 超声引导下连续胸椎旁阻滞可减轻开腹肝切除术患者围术期疼痛并减少其阿片类药物用量。我们假设该效应可能改善开腹肝切除术后患者的恢复质量(quality of recovery,QoR)。
方法 76例接受开腹肝切除术的患者随机接受罗哌卡因(CTPVB组)或生理盐水(对照组)连续胸椎旁阻滞。所有患者术后均接受吗啡静脉自控镇痛48小时。主要结局是术后第7天的全维度中文版-15项QoR评分,采用Student t检验进行统计分析。
结果 CTPVB组36名患者和对照组37名患者完成了研究。与对照组相比,CTPVB组在术后第7天全维度中文版-15项QoR总分(133.14±12.97 vs. 122.62±14.89,P=0.002)显著提高。CTPVB组术后疼痛评分和累积吗啡消耗量分别在8小时和48小时内显著降低(P<0.05;P=0.002)。
结论 围手术期CTPVB能显著提高开腹肝切除术后患者的QoR,在术后早期可提供良好的镇痛效果。

关键词: 胸椎旁阻滞, 肝切除术, 恢复质量, 罗哌卡因

Abstract:

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy.
Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student’s t-test.
Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group.
Conclusion Perioperative CTPVB markably promotes patient’s QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.

Key words: thoracic paravertebral block, hepatectomy, quality of recovery, ropivacaine

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