全麻复合腹横肌平面阻滞对老年患者术后恢复及肠道功能的影响  

Effects of general anesthesia combined with transversus abdominis plane block on intestinal barrier function in elderly patients undergoing abdominal operation

作　　者：陶涛[1] 郑晖[1] 郭小文[1] TAO Tao ZHENG Hui GUO Xiaowen.(Department of Anesthesiology, the First Affiliated Hospital of ZhejiangChinese Medical University, Hangzhou 310006, China)

机构地区：[1]浙江中医药大学附属第一医院麻醉科,杭州310006

出　　处：《浙江医学》2017年第20期1774-1777,共4页Zhejiang Medical Journal

摘　　要：目的比较全麻复合腹横肌平面阻滞(TAP)与单纯全麻对老年腹部手术患者肠道功能的影响。方法选取择期行腹部手术的老年患者60例,按数字随机表法分为全麻联合TAP组(A组)、单纯全麻组(B组),每组30例。A组患者在全麻后行超声引导下双侧肋缘下TAP,B组采用单纯全麻。分别记录麻醉前、手术结束时和术后第1、3、5天各时点平均动脉压(MAP)、心率(HR)、脉博血氧饱和度(SpO_2),测定D-乳酸及小肠型脂肪酸结合蛋白(I-FABP)浓度,行肠功能评分及疼痛评分,记录术后首次通气时间、通便时间、下床活动时间及术后并发症的发生情况。结果两组患者MAP、HR在手术结束时、术后第1天较麻醉前有明显变化(P<0.05),在手术结束时A组较B组低(P<0.05);D-乳酸浓度及I-FABP在手术结束时、术后第1、3天较麻醉前有明显升高(P<0.05),在手术结束时A组较B组低(P<0.05);肠功能评分及疼痛评分在手术结束时、术后第1、3天较麻醉前有明显升高(P<0.05),疼痛评分在手术结束时、术后第1天A组较B组低(P<0.05);术后首次通气时间、通便时间A组较B组早(P<0.05),下床活动时间及术后并发症组间比较无统计学意义(P>0.05)。结论全麻复合TAP对老年腹部手术患者肠屏障功能有保护作用。Objective To investigate the effects of general anesthesia （GA） combined with transversus abdominis plane （TAP） block on intestinal barrier function in the elderly patients undergoing abdominal surgery. Methods Sixty patients undergoing selective abdominal surgery were randomly divided into 2 groups with 30 cases in each group. In group A subcostal ultrasound-guided TAP block was performed after GA in both sides; in group B patients were given GA only. MAP, HR, Sp〇2 , plasma concentrations of D-LAC and I-FABP, bowel function score and VAS score before general anesthesia, at the end of operation, and P〇D1, P〇D3, P〇D5 were recorded. The time to first anal exhaust, defecation, and ambulation, and surgery-related complication were also been recorded. Results There were significant differences in MAP and HR at the end of operation and P〇D1 compared to those before GA （P〈0.05） in both groups; and the MAP and HR at the end of operation in group A were lower than those in group B （P〈0.05）. At the end of operation, P〇D1 and P〇D3, plasma D-LAC and I-FABP levels in both groups were significantly higher than those before GA （P〈0.05）, and the above indicators in group A were lower than those in group B at the end of operation （P〈0.05）. Similarly, bowel function score and VAS score were significantly higher at the end of operation, P〇D1, P〇D3 than that before GA （P〈0.05） in both groups; and VAS in group A was lower than that in group B at the end of operation and P〇D1 （P〈0.05）. Besides, the time to first anal exhaust, defecation in group A was earlier than that in group B （P〈0.05）, while no significant difference in times to the first ambulation and incidence of complications between group A and group Bwas observed （P 〉0.05）. Conclusion GA combined with TAP block is protective for intestinal barrier function in the elderly patients undergoing abdominal surgery.

关 键 词：全身麻醉 腹横肌平面阻滞 老年患者 腹部手术 肠屏障功能 

分 类 号：R614[医药卫生—麻醉学]