布比卡因脂质体对腹腔镜肝切除术术后恶心呕吐的影响

doi:10.3760/cma.j.cn441417-20250509-22015

摘要/Abstract

摘要： 目的　探讨布比卡因脂质体（liposomal bupivacaine，LB）作为神经阻滞的局麻药对行腹腔镜特殊肝段切除术患者术后恶心呕吐（postoperative nausea and vomiting，PONV）的影响。方法　选取2025年1月至3月在复旦大学附属中山医院厦门医院行腹腔镜下特殊肝段切除术的患者96例进行随机对照试验。采用随机数字表法将其分为对照组和研究组，各48例。对照组男26例，女22例，年龄（52.90±13.67）岁，体重指数（22.92±3.26）kg/m²。研究组男34例，女14例，年龄（53.81±14.13）岁，体重指数（23.61±3.77）kg/m²。研究组使用LB进行超声引导下神经阻滞联合全身麻醉，对照组单纯全身麻醉。对比两组术后48 h PONV发生率和发生次数（依据次数进行分级）、阿片类药物总用量、手术时间、术后住院时间、术后镇痛效果满意度。采用t检验、χ²检验、秩和检验进行统计分析。结果　研究组PONV总次数少于对照组（4次比17次），差异有统计学意义（P<0.05）；研究组4次PONV均为Ⅰ级，对照组17次PONV分布于Ⅰ～Ⅳ级之间，差异有统计学意义（P<0.01）。研究组术中舒芬太尼总用量少于对照组［（30.08±10.30）μg比（48.71±13.99）μg］，差异有统计学意义（均P<0.01）。两组首次下床时间、术后住院时间以及手术时间差异均无统计学意义（均P>0.05）；研究组术后镇痛效果满意度高于对照组［97.9%（47/48）比85.4%（41/48）］，差异有统计学意义（P<0.05）。结论　LB作为神经阻滞的局麻药在腹腔镜特殊肝段切除术围手术期中应用，不仅能改善患者对围手术期麻醉的满意度，还能减少阿片类药物使用剂量，进而减少PONV的发生。

关键词: 神经阻滞, 布比卡因脂质体, 腹腔镜肝段切除术, 满意度

Abstract:

Objective　To investigate the effect of liposomal bupivacaine (LB) as a local anesthetic for nerve block on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic atypical hepatectomy. Methods　Ninety-six patients who underwent laparoscopic atypical hepatectomy at Xiamen Branch, Zhongshan Hospital, Fudan University between January and March 2025 were selected for the randomized controlled trial. The patients were divided into a control group and a study group by the random number table method, with 48 cases in each group. The control group consisted of 26 males and 22 females; they were (52.90±13.67) years old; their body mass index (BMI) was (22.92±3.26) kg/m². The study group consisted of 34 males and 14 females; they were (53.81±14.13) years old; their BMI was (23.61±3.77) kg/m². The study group received ultrasound-guided nerve block with LB and general anesthesia, while the control group received general anesthesia alone. The incidence rates and frequencies (graded according to it) of PONV 48 h after the operation, total intraoperative opioid consumptions, operation times, postoperative hospitalization times, and perioperative anesthesia satisfaction were compared between the two groups. Statistical analyses were performed using the t, χ², and rank-sum tests. Results　The total number of PONV episodes in the study group was significantly lower than that in the control group (4 times vs. 17 times), with a statistical difference (P<0.05). All the 4 PONV episodes in the study group were grade Ⅰ, and the 17 PONV episodes in the control group were grades Ⅰ-Ⅳ, with a statistical difference (P<0.01). The total intraoperative sufentanil consumption in the study group was less than that in the control group [(30.08±10.30) μg vs. (48.71±13.99) μg], with a statistical difference (P<0.01). There were no statistical differences between the two groups in the time to first ambulation, postoperative hospitalization time, and operation time (all P>0.05). The patient satisfaction with analgesic effect in the study group was higher than that in the control group [97.9% (47/48) vs. 85.4% (41/48)], with a statistical difference (P<0.05). Conclusion　The use of LB as a local anesthetic for nerve block in the perioperative period of laparoscopic atypical hepatectomy not only can improve the patient satisfaction with perioperative anesthesia, but also can reduce the usage of intraoperative opioid and the incidence of PONV.

Key words:

Nerve block, Liposomal bupivacaine, Laparoscopic hepatic segmentectomy, Patient satisfaction

应美晶李玮珊童颉梁超. 布比卡因脂质体对腹腔镜肝切除术术后恶心呕吐的影响[J]. 国际医药卫生导报, 2025, 31(22): 3775-3778.

Ying Meijing, Li Weishan, Tong Jie, Liang Chao. Effect of liposomal bupivacaine on postoperative nausea and vomiting after laparoscopic hepatectomy[J]. International Medicine and Health Guidance News, 2025, 31(22): 3775-3778.

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