B 超引导腹横肌平面阻滞应用于老年患者腹腔镜直肠癌根治术后镇痛效果及对机体免疫功能的影响研究

Postoperative analgesic effect and impact on immune function of ultrasound guided transversus abdominis plane block used in elderly patients after laparoscopic radical resection of rectal cancer

摘要:

目的 观察B 超引导腹横肌平面阻滞应用于老年患者腹腔镜直肠癌根治术后镇痛效果及对机体 免疫功能的影响。方法 60 例需行腹腔镜直肠癌根治术的老年患者，按照入院顺序编号采取数字随机法分 为腹横肌平面阻滞组及生理盐水对照组。腹横肌平面阻滞组于全麻诱导后行B 超引导腹横肌平面阻滞，静 注0.25% 盐酸罗哌卡因30 ml ；生理盐水对照组静注等容量生理盐水。术后均给予静脉镇痛泵：舒芬太尼 1.00μg/kg+ 昂丹司琼16.00 mg+ 地佐辛10.00 mg+ 生理盐水配置成100 ml，设置2 ml/h，自控时间15 min。 观察两组麻醉前（T0）、术后1 h（T1）、术后12 h（T2）、术后24 h（T3）及术后48 h（T4）的视觉模拟评分（VAS） 及血流动力学相关指标；记录术后24 h 镇痛泵按压次数及舒芬太尼使用总量；并抽取静脉血采取流式细胞仪 测定CD4+%、CD8+% 水平，应用酶联免疫吸附法测定γ 干扰素（IFN-γ）水平；比较两组术后不良反应。 结果 与生理盐水对照组比较，腹横肌平面阻滞组于T1 和T2 时点平均动脉压（MAP）降低，T1、T2 及T3 时 点心率（HR）降低（均P <0.05）；腹横肌平面阻滞组组内比较，T1 时点MAP 高于T0 时点，T1 和T2 时点 HR 高于T0 时点（均P <0.05）。与生理盐水对照组比较，腹横肌平面阻滞组于T1、T2、T3 和T4 时点VAS 评 分均更低，且术后24 h 按压次数及舒芬太尼总量均降低（均P <0.05），CD4+% 水平均升高，IFN-γ 水平T2 和T3 时点均升高（均P <0.05）；不良反应发生率降低（P <0.05）。结论 B 超引导腹横肌平面阻滞应用于老 年患者腹腔镜直肠癌根治术后镇痛效果较佳，血流动力学平稳，术后疼痛程度更低，对机体免疫能力具有一定 保护作用，且不良反应发生率低，临床应用安全。

Abstract:

Objective To observe the effect of ultrasound guided transversus abdominis plane block used in laparoscopic radical resection of rectal cancer in elderly patients on postoperative analgesic and impact on immune function. Methods Sixty cases need laparoscopic radical resection of rectal cancer in elderly patients with admission order number to take the digital randomized method was divided into abdominal transverse muscle block group and saline control group. The transversus abdominis plane block group underwent ultrasound guided transversusabdominis plane block after induction of general anesthesia while accepted intravenous injection of 0.25% ropivacaine hydrochloride of 30 ml; Saline control group took equal volume intravenous saline. After operation all were given analgesia pump: Sufentanil 1.00 μg/kg + Ondansetron 16.00 mg + Dezocine 10.00 mg + saline to configure for 100 ml, and set 2 ml/h and 15 min of automatic control time. To observe visual analogue score (VAS) and related indexes of hemodynamics before anesthesia (T0), 1 h after operation (T1), 12 h after operation (T2), 24 h after operation (T3) and 48 h after operation (T4) between two groups; Record 24 h analgesia pressing times and total postoperative Sufentanil; And take venous blood to measure CD4+%, CD8+% level by flow cytometry and determinate interferon gamma (IFN-γ) by enzyme-linked immunosorbent assay; Then compare postoperative adverse reactions of two groups. Results Compared with saline control group,transversus abdominis plane block group’ MAP decreased in T1, T2, and HR decreased in T2 and T3 (P < 0.05). Transversus abdominis plane block groups’ MAP in T1 was higher than T0, and HR in T1, T2 was higher than that of T0 (P < 0.05). Compared with saline control group, transversus abdominis plane block group’ VAS scores were lower at the T1, T2, T3, T4, else postoperative 24 h pressing times and amount of Sufentanil were decreased (P < 0.05). Compared with saline control group, transversus abdominis plane block group’ CD4+% levels increased in T1, T2, T3 and T4, IFN-γ levels in T2, T3 points were higher (P < 0.05). Compared with the saline control group, transversus abdominis plane block group’ rate of adverse reactions was lower (P < 0.05). Conclusion Ultrasound guided transversus abdominis plane block used in laparoscopic radical resection of rectal cancer in elderly patients has better postoperative analgesic effect, stable hemodynamics and less postoperative pain, and it has protective effect on immune function and lower incidence of adverse reactions, so clinical application is safety.