Comparison of the Level of Intraoperative Nociception between Laparoscopic and Open Hepatic Resection
Comparison of the Level of Intraoperative Nociception between Laparoscopic and Open Hepatic Resection
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DOI：
10.5754/hge141103
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发表时间：
2015-03-01
影响因子：
--
通讯作者：
Hirose, Munetaka
中科院分区：
文献类型：
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作者：
Hashimoto, Kazuma;Miyawaki, Hiroki;Hirose, Munetaka
背景/目的：充分抑制围手术期疼痛对于确保良好的术后结局非常重要。虽然腹腔镜手术的伤害性感受水平一般低于开腹手术，但没有足够的证据支持肝切除术的伤害性感受水平。方法学：为了建立一种回顾性评估术中伤害性水平的方法，我们收集了三种术中不同伤害性水平的手术中心率、灌注指数、收缩压的平均值。在我们使用这些变量验证了判别分析在回顾性评价手术过程中伤害感受的实用性后，我们对接受腹腔镜或开放性肝切除术的患者进行了这项分析。结果如下：倾向评分匹配前，开腹组与腹腔镜组的判别评分差异有统计学意义，匹配后两组的判别评分差异无统计学意义。结论：腹腔镜肝切除术中的耐受水平可能与开腹肝切除术相似。与开放手术一样，全麻下腹腔镜手术可能需要一种果断的抗伤害性策略。
Background/Aims: Sufficient suppression of periop, erative nociception is important for ensuring favorable postoperative outcomes. Although the level of nociception during laparoscopic surgery is generally lower than during laparotomy, there is insufficient evidence to support this for hepatic resection. Methodology: To develop a method to retrospectively evaluate the intraoperative nociceptive level, we collected data of intraoperative averaged values of heart rate, perfusion index, systolic blood pressure during three surgeries with different levels of intraoperative nociception. After we validated the utility of discriminant analysis using these variables for the retrospective evaluation of nociception during surgery, we performed this analysis in patients who -underwent either laparoscopic or open hepatic resectiOn. Results: Although there was a significant difference in discriminant score between the open and the laparoscopic hepatic resection groups before propensity score matching, discriminant score showed no significant difference between two groups after matching. Conclusions: The level of notiception during laparoscopic hepatic resection is likely similar to that during open hepatic resection. An assertive anti-nociceptive strategy might be required for laparostopic procedures under general anesthesia, as with open procedures.