腹橫肌平面阻滯與切口局部浸潤麻醉對單孔腹腔鏡膽囊切除術患者切口疼痛及炎癥應激反應的影響*

【摘要】 目的：探討腹橫肌平面阻滯（TAPB）與切口局部浸潤麻醉（LIA）對單孔腹腔鏡膽囊切除術（SILC）患者切口疼痛及炎癥應激反應的影響。方法：選擇2022年6月—2024年6月中山市東鳳人民醫院普外科收治的94例接受SILC的患者，并隨機分為兩組，每組47例。兩組均接受SILC，觀察組進行TAPB，對照組進行切口LIA。比較兩組數字分級評分法（NRS）、炎癥因子[腫瘤壞死因子-α（TNF-α）、白細胞介素-6（IL-6）、白細胞介素-8（IL-8）]水平及住院時間。結果：觀察組術后30 min、2 h、6 h NRS評分均顯著低于對照組，差異均有統計學意義（Plt;0.05）。術后1周，觀察組TNF-α、IL-6、IL-8水平均低于對照組，差異均有統計學意義（Plt;0.05）。觀察組住院時間短于對照組（Plt;0.05）。結論：TAPB應用于SILC患者，不僅可顯著減輕患者疼痛程度，還可減輕炎癥應激反應，促進患者快速康復。

【關鍵詞】 腹橫肌平面阻滯 切口局部浸潤麻醉 單孔腹腔鏡膽囊切除術 疼痛 炎癥應激反應

Effects of Transversus Abdominis Plane Block and Incision Local Infiltration Anesthesia on Incision Pain and Inflammatory Stress Response in Patients Undergoing Single Incision Laparoscopic Cholecystectomy/MEI Feng， GAN Wen， XU Weihong， YU Hanhui， LONG Xiangliang. //Medical Innovation of China， 2025， 22（06）： 021-024

[Abstract] Objective： To investigate the effects of transversus abdominis plane block （TAPB） and incision local infiltration anesthesia （LIA） on incision pain and inflammatory stress response in patients undergoing single incision laparoscopic cholecystectomy （SILC）. Method： A total of 94 patients received SILC admitted to Department of General Surgery， Zhongshan Dongfeng People's Hospital from June 2022 to June 2024 were selected and randomly divided into two groups， with 47 cases in each group. Both groups received SILC， the observation group received TAPB， and the control group received incision LIA. The numerical rating scale （NRS）， the levels of inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and interleukin-8 （IL-8）] and hospital stay were compared between the two groups. Result： NRS scores 30 min， 2 h and 6 h after operation in the observation group were significantly lower than those in the control group， the differences were statistically significant （Plt;0.05）.

1 weeks after operation， the levels of TNF-α， IL-6 and IL-8 in observation group were lower than those in control group， the differences were statistically significant （Plt;0.05）. The hospital stay in the observation group was shorter than that in the control group （Plt;0.05）. Conclusion： The application of TAPB in patients undergoing SILC can not only significantly reduce the degree of pain， but also alleviate inflammatory stress response and promote rapid recovery of patients.

[Key words] Transversus abdominis plane block Incision local infiltration anesthesia Single incision laparoscopic cholecystectomy Pain Inflammatory stress response

First-author's address： Department of General Surgery， Zhongshan Dongfeng People's Hospital， Zhongshan 528425， China

doi：10.3969/j.issn.1674-4985.2025.06.005

隨著微創外科技術的進步與創新，膽囊切除術經歷了從開腹手術到傳統腹腔鏡手術，再到更為先進的單孔腹腔鏡手術的演變[1]。但有研究發現，單孔腹腔鏡膽囊切除術（SILC）在緩解術后疼痛方面并未帶來顯著優勢，尤其是切口疼痛問題，依然是影響患者迅速恢復的關鍵因素[2]。鑒于此，術后鎮痛策略的探索成為醫學界新的研究熱點。繼切口局部浸潤麻醉（LIA）和腹直肌鞘神經阻滯（RSB）之后，腹橫肌平面阻滯（TAPB）作為一種新興的術后鎮痛方法，逐漸受到關注并應用于臨床[3]。疼痛的產生不僅涉及局部組織反應，還涉及炎癥應激反應，故腫瘤壞死因子-α（TNF-α）、白細胞介素-8（IL-8）、白細胞介素-6（IL-6）等炎癥因子水平的變化，對于評估鎮痛效果及機體恢復情況具有重要意義[4]。……