全麻联合硬膜外阻滞与腹横肌平面阻滞对结直肠癌根治术患者术后恢复的影响  

Effects of general anesthesia combined with epidural block or transverse abdominis plane block on intraoperative anesthetic dosages,stress response and inflammatory response in patients undergoing radical resection of colorectal cancer

作　　者：杨蓉蓉[1] 徐兴国[1] 黄新冲[1] YANG Rong-rong;XU Xing-guo;HUANG Xin-chong(Department of Anesthesiology,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属医院麻醉科

出　　处：《医学研究生学报》2019年第10期1070-1075,共6页Journal of Medical Postgraduates

摘　　要：目的结直肠癌根治术围术期镇痛方案的选择尚存在争议。文中旨在比较全麻分别联合硬膜外阻滞与腹横肌平面阻滞对患者手术恢复的影响,为结直肠癌根治术镇痛方式的选择提供依据。方法回顾性分析2016年2月至2018年5月于南通大学附属医院118例行全麻下腹腔镜结直肠癌根治术患者临床资料。对所有纳入的研究对象按照麻醉方案分为硬膜外阻滞组(n=61)和腹横肌平面阻滞组(n=57)。2组患者全麻诱导及维持用药一致。记录2组患者术中全麻药物用量,比较术后恢复情况,包括肛门首次排气、进食时间、下床活动时间、住院时间及疼痛视觉模拟评分等,检测不同时间点心率、平均动脉压(M AP)、血氧饱和度(SpO2)、皮质醇(Cor)、去甲肾上腺素(N E)等应激指标,CD4+、CD8+、CD4+/CD8+、总T淋巴细胞计数、自然杀伤细胞(N K)计数等免疫指标,以及人趋化因子CXC配体8(CXCL8)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)等炎症指标的变化。结果硬膜外阻滞组舒芬太尼用量低于腹横肌平面阻滞组([25.36±4.74)g vs(28.43±3.69)g,P<0.01];硬膜外阻滞组患者肛门首次排气时间、进食时间、首次下床活动时间均少于腹横肌平面阻滞组(P<0.05);硬膜外阻滞组术后不同时间点VAS评分皆低于腹横肌平面阻滞组(P<0.01);硬膜外阻滞组气腹建立后5min至放气后5min心率、MAP、Cor、NE均低于腹横肌平面阻滞组相应时间点,气腹建立后5 min SpO2低于同时间点腹横肌平面阻滞组([5.11±0.31)%vs(5.96±0.34)%,P<0.05]。术后24h,硬膜外阻滞组CD8+([20.79±13.02)%v(2s 6.91±10.22)%]、总T细胞([60.23±8.97)%v(6s 4.33±12.76)%]低于腹横肌平面阻滞组,CD4+/CD8+([1.66±0.63)v s(1.25±0.95)、]NK细胞计数([27.71±10.98)%v(2s 0.02±1.74)%]高于腹横肌平面阻滞组,差异均有统计学意义(P<0.05);CXCL8、IL-6、TNF-α水平低于腹横肌平面阻滞组,差异均有统计学意义(P<0.05)。2组患者不良�Objective The choice of perioperative analgesia regimens for radical resection of colorectal cancer is still controversial.The purpose of this study was to compare the effects of general anesthesia combined with epidural block or transverse abdominisplane block on surgical recovery of patients,and provide a basis for the choice of analgesic methods for radical resection of colorectal cancer.Methods The clinical data of 118 patients who underwent laparoscopic radical resection of colorectal cancer under general anesthesia in Affiliated Hospital of Nantong University between February 2016 and May 2018 were retrospectively analyzed,and the patients were divided into group A(epidural block,n=61)and group B(transverse abdominis plane block,n=57)according to anesthesia regimens.The two groups were given the same general anesthesia induction and maintenance medication.The dosages of general anesthetics in two groups were recorded,and the postoperative recovery situations(including first anal exhaust time,eating time,ambulation time,hospital stay and visual analogue scale score)were compared,and the stress indexes of heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2),cortisol(Cor)and norepinephrine(NE)],immune indexes of CD4+,CD8+,CD4+/CD8+,total T lymphocyte count and natural killer cell(NK)count and inflammation indicators of human chemokine CXC ligand 8(CXCL8),interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)were detected in two groups at different time points.Results The dosage of sufentanil in group A was lower than that in group B[(25.36±4.74)μg vs(28.43±3.69)μg](P<0.001).The first anal exhaust time,eating time and first ambulation time in group A were shorter than those in group B(P<0.05).The VAS scores in group A were lower than those in group B at different time points(P<0.001).The levels of HR,MAP,Cor and NE in group A were lower than those in group B at T2~T3,and the SpO2 at T2 was lower than that in group B[(5.11±0.31)%vs(5.96±0.34)%](P<0.05).At 24h after operation,the CD8+and

关 键 词：结直肠癌 全麻 硬膜外阻滞 腹横肌平面阻滞 应激 

分 类 号：R735.3[医药卫生—肿瘤]