超声引导腹横肌平面阻滞复合全麻在中低位直肠癌中的应用效果  

Effect of ultrasound-guided abdominal transverse plane block combined with general anesthesia application in moderate-low rectal cancer

作　　者：蔡云亮[1] 史嘉华 朱红[1] 纪宏新[1] 王新[1] 潘春杰[1] 袁小刚[1] 李安学[1] Cai Yunliang;Shi Jiahua;Zhu Hong;Ji Hongxin;Wang Xin;Pan Chunjie;Yuan Xiaogang;Li Anxue(The People's Hospital of Shenzhen Longgang District,Shenzhen 518172,China)

机构地区：[1]广东省深圳市龙岗区人民医院

出　　处：《广西医科大学学报》2019年第11期1773-1778,共6页Journal of Guangxi Medical University

基　　金：广东省医学基金资助项目（No.B2016022）;深圳市知识创新计划-基础研究课题资助项目（No.JCYJ20150402164-314693）

摘　　要：目的:探讨超声引导下腹横肌平面阻滞复合全身麻醉在中低位直肠癌手术中的应用效果。方法:选取2016年1月至2018年5月广东省深圳市龙岗区人民医院收治的中低位直肠癌患者80例,将其随机分为观察组与对照组,每组40例。观察组行超声引导下腹横肌平面阻滞复合全身麻醉,对照组行单纯全身麻醉。比较两组围术期血流动力学指标、氧化应激指标、免疫功能指标变化。结果:围术期观察组平均动脉压(MAP)、心率(HR)水平波动幅度小于对照组(P<0.05);观察组苏醒时间、气管插管拔管时间短于对照组,舒芬太尼、丙泊酚用量少于对照组(P<0.05);术后4 h、8 h、12 h观察组术后疼痛程度(VAS)评分低于对照组(P<0.05);术后两组血清C反应蛋白(CRP)、皮质醇(Cr)水平及CD4^+CD25^+均较术前升高(P<0.05),CD4^+、CD4^+/CD8^+较术前降低(P<0.05),但观察组升高幅度小于对照组(P<0.05)。结论:超声引导下腹横肌平面阻滞复合全身麻醉在中低位直肠癌手术中的应用有利于维持围术期血流动力学稳定,麻醉效果显著,术后苏醒质量高,且可有效缓解术后疼痛、减轻炎性及应激反应,对机体免疫功能影响亦较小。Objective:To explore the effect of ultrasound-guided transversal abdominis plane block combined with general anesthesia application in moderate-low rectal cancer.Methods:Eighty patients with moderate-low rectal cancer were randomly divided into an observation group and a control group,with 40 cases in each group.The patients in the observation group underwent ultrasound-guided abdomen transverse muscle plane block combined with general anesthesia,and those in the control group underwent general anesthesia.Perioperative hemodynamic parameters,oxidative stress indicators,and immune function changes were compared between the two groups.Results:The fluctuations of MAP and HR levels in the observation group were smaller than those in the control group(P<0.05).The recovery time and tracheal extubation time in the observation group were shorter than those in the control group,and the dosage of sufentanil and propofol as well as the VAS score at 4 h,8 h,and 12 h after operation were lower(P<0.05).The levels of serum CRP,Cr,CD4^+and CD4^+CD25^+ levels as well as CD4^+/CD8^+ ratio after operation were changed in both groups,and the changes were more significant in the control group(P<0.05).Conclusion:Ultrasound-guided transversal abdominis plane block combined with general anesthesia for moderate-low rectal cancer surgery is beneficial to maintain perioperative hemodynamic stability,significant anesthetic effect,and high postoperative recovery.It can effectively relieve postoperative pain and reduce inflammatory response,having little effect on immune function.

关 键 词：中低位直肠癌 全身麻醉 超声引导下腹横肌平面阻滞 

分 类 号：R735.37[医药卫生—肿瘤]