腹横肌平面阻滞应用于腹腔镜下肝癌切除术患者术后镇痛及对机体免疫功能的影响

Postoperative analgesia and impact on immune function of transverse abdominis plane block applied to patients with laparoscopic hepatectomy

摘要:

观察腹横肌平面阻滞（TAPB）应用于腹腔镜下肝癌切除术患者术后镇痛及对机体免疫功能的影响。方法 106例肝癌患者根据随机数字表法分为TAPB组和对照组，两组均采取气管内插管全身麻醉，TAPB组麻醉后行双侧腹横肌平面阻滞，定位明确后，缓慢推注0.3%盐酸罗哌卡因25 ml，对照组推注等剂量生理盐水，手术结束时均给予静脉自控镇痛泵。比较两组患者术中丙泊酚、瑞芬太尼用量、苏醒时间、术后不同时刻疼痛程度、术后镇痛药物舒芬太尼用量、镇痛泵按压次数和术后不同时刻免疫功能情况，记录不良反应情况。结果 TAPB组丙泊酚、瑞芬太尼总量、拔管时间、恢复室停留时间、术后1、24和48 h的视觉模拟评分（VAS）、术后24 h内舒芬太尼总量和镇痛泵按压次数均低于对照组（均P <0.05）；TAPB组术后24 h NK细胞、CD4+ T淋巴细胞及CD4+/CD8+比值均高于对照组，CD8+ T淋巴细胞水平低于对照组（均P <0.05）；TAPB组不良反应发生率明显低于对照组（P <0.05）。结论 TAPB应用于腹腔镜下肝癌切除术可减少术中及术后镇痛药物用量，镇痛效果更佳，且具有免疫功能保护作用，不良反应发生率低，值得推广。

Abstract:

To observe postoperative analgesia and impact on immune function of transverse abdominis plane block applied to patients with laparoscopic hepatectomy. Methods According to random number table method, 106 cases of liver cancer patients were divided into TAPB group and control group, patients in the two groups received endotracheal intubation general anesthesia, the observation group accepted transverse abdominis plane block after anesthesia while slowly push 0.3% Ropivacaine hydrochloride 25 ml after positioning clear then, control group received isodose physiological saline, at the end of surgery all the patients were given intravenous self-control analgesia pump. Then compare the amount of Propofol, Remifentanil, the time of waking, the degree of postoperative pain, the amount of postoperative analgesic drug Sufentanil, the number of times of analgesic pump press, and the immune function at different postoperative times in the two groups, and record the adverse reactions. Results The amount of Propofol, Remifentanil, catheter pulling time, recovery room stay time, VAS score at 1 h postoperatively, 24 h postoperatively , total amount of Sufentanil and number of analgesic pump presses in TAPB group were lower than those in the control group (all P < 0.05). The NK cells, CD4+ T lymphocytes, and CD4+/CD8+ ratios were higher in TAPB group at 24 h after surgery, and CD8+ levels were lower in the observation group than in the control group (all P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (P < 0.05). Conclusion The application of transverse abdominis plane block in laparoscopic hepatectomy can reduce the amount of analgesic drugs in operation and after operation, analgesic effect is better, and it has immune function protection, adverse reaction rate is low, it is worth popularizing.