Objective: To investigate the clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer. Methods: A perspective study was conducted to collect data of patients with liver cancer who underwent partial hepatectomy from March 2014 to March 2015.The 90 patients involved in the study were randomly divided into two groups as multimodal analgesia and control groups, and each group had 45 cases. In multimodal analgesia group, 40 mg parecoxib sodium was injected intravenously 30 minutes before anesthetic induction, and 0.375% ropivacaine 150 mg combined with dexamethasone 5 mg were applied to transversus abdominis plane block before closing abdomen.The patients in control group without above treatment. Patient controlled intravenous analgesia was used in all patients. Three days after surgery, 40 mg parecoxib sodium was injected intravenously, twice a day for all patients.Visual analogue scales (VAS) was used to evaluate postoperative pain, and postoperative adverse events were observed.The number of cases of postoperative ambulation (>6 h for every day), time of flatus and defecation, and duration of hospital stay were recorded in two groups.Pearson chi-square test was used to compare the rate or constituent ratio between two groups.Independent sample t test or Mann-Whitney U was used to analyzed the measurement data between two groups. Results: There were no difference between two groups in aging, gender, weight, body mass index, ASA classification, blood loss volume, time of operation(all P>0.05). The scores of VAS in multimodal analgesia group was significantly lower than that in control group(3.0±0.8 vs. 4.6±1.1, t=7.814, P<0.01 for day 1; 2.2±1.0 vs. 3.6±1.2, t=5.825, P<0.01 for day 2; 1.6±0.8 vs. 2.4±1.2, t=3.894, P<0.01 for day 3). The number of cases of postoperative ambulation(>6 h) in multimodal analgesia group was significantly more than that in control group (10 cases vs. 0 case, χ(2)=11.250, P<0.01 for day 1; 21 cases vs. 5 cases, χ(2)=13.846, P<0.01 for day 2; 28 cases vs. 17 cases, χ(2)=5.378, P =0.020 for day 3). The time of flatus and defecation, and duration of hospital stay were significantly shorter than that in control group((30.2±7.3) hours vs. (36.4±7.0)hours, t=4.115, P<0.01 for flatus; (50.9±5.2)hours vs. (60.7±7.3)hours, t=7.346, P<0.01 for defecation; (6.2±0.8)days vs. (9.6±1.1)days, t=16.615, P<0.01 for hospital stay). Conclusion: Multimodal preventive analgesia effectively alleviate the postoperative pain, benefits early ambulation, improves recovery of gastrointestinal function, and shortens duration of hospital stay in patients with partial hepatectomy for liver cancer.
目的：探讨多模式预防性镇痛在行肝部分切除术的肝癌患者中的应用价值。 方法：前瞻性收集2014年3月至2015年3月安徽医科大学附属省立医院肝脏外科收治的90例行肝部分切除术的肝癌患者资料，随机分为两组，每组45例。多模式预防性镇痛组麻醉诱导前30 min静脉注射帕瑞昔布钠40 mg，关腹前用0.375%的罗哌卡因150 mg联合5 mg地塞米松行腹横肌平面阻滞，对照组不做此处理。两组患者术后均常规携带自控式静脉镇痛泵，术后前3 d静脉滴注40 mg帕瑞昔布钠，每日两次。采用视觉模拟评分(VAS)评估两组患者术后疼痛程度，观察不良反应发生情况，记录术后下床活动超过6 h的病例数、肛门排气、排便及住院时间。两组患者构成比或率的比较用Pearson χ(2)检验；两组间等级资料的比较采用独立样本t检验或Mann－Whitney U秩和检验。 结果：两组患者的年龄、性别、体重、体重指数、ASA分级、术中出血量及手术时间方面的差异均无统计学意义(P值均>0.05)。多模式预防性镇痛组术后1、2、3 d VAS平均值均低于对照组，差异有统计学意义(术后1 d：3.0±0.8比4.6±1.1，t＝7.814，P<0.01；术后2 d：2.2±1.0比3.6±1.2，t＝5.825，P<0.01；术后3 d：1.6±0.8比2.4±1.2，t＝3.894，P<0.01)；多模式预防性镇痛组术后1、2、3 d每日下床活动时间超过6 h的病例数均多于对照组，差异有统计学意义(术后1 d：10例比0例，χ(2)＝11.250，P<0.01；术后2 d：21例比5例，χ(2)＝13.846，P<0.01；术后3 d：28例比17例，χ(2)＝5.378，P ＝0.020)；多模式预防性镇痛组术后肛门排气、排便及住院时间短于对照组，差异均有统计学意义[(30.2±7.3)h比(36.4±7.0)h，t＝4.115，P<0.01；(50.9±5.2)h比(60.7±7.3)h，t＝7.346，P<0.01；(6.2±0.8)d比(9.6±1.1)d，t＝16.615，P<0.01]。 结论：多模式预防性镇痛能够有效减轻肝癌患者肝部分切除术后的疼痛，有利于患者早期下床活动，促进了胃肠功能恢复，缩短了住院时间。.
Keywords: Hepatectomy; Liver neoplasms; Multimodal preventive analgesia.