超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜结直肠癌根治术中的应用效果  

Application effect of ultrasound-guided transverse abdominal planar block combined with general anesthesia in the laparoscopic radical resection of colorectal cancer

作　　者：鞠峰[1] 张先杰[1] 赵枝富 JU Feng;ZHANG Xianjie;ZHAO Zhifu(Department of Anesthesiology,Deyang People's Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院麻醉科

出　　处：《中国癌症防治杂志》2019年第6期523-527,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：德阳市科技计划项目（2018SZS090）

摘　　要：目的探讨超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜结直肠癌根治术中的临床应用效果。方法选取2017年6月至2019年6月在德阳市人民医院行腹腔镜结直肠癌根治术的100例患者为研究对象。根据随机数字表分为对照组(n=50)和观察组(n=50)。对照组给予全身麻醉,观察组在此基础上联合超声引导下腹横肌平面阻滞,比较两组血流动力学、镇痛效果及不良反应等情况。结果观察组切皮时、癌灶切除时及术毕时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、丙泊酚用量、舒芬太尼用量、呼之睁眼时间、拔气管时间、完全苏醒时间以及术后2h、12 h、24 h、48 h、72 h的VAS评分均低于对照组(P<0.05);术后24 h内镇痛泵按压次数、补救性镇痛次数亦低于对照组(P<0.001),但镇痛满意率高于对照组(96.0%vs 82.0%,χ~2=5.005,P=0.025)。两组患者不良反应发生率比较差异无统计学意义(10.0%vs 14.0%,χ~2=0.379,P=0.538)。结论超声引导下腹横肌平面阻滞联合全麻可有效改善腹腔镜结直肠癌根治术患者镇痛效果,稳定血流动力学,减少全麻用药量,安全性较好,值得临床推广应用。Objective To explore the clinical application effect of ultrasound-guided transverse abdominal planar block combined with general anesthesia in the laparoscopic radical resection of colorectal cancer. Methods From June 2017 to June 2019,100 patients undergoing laparoscopic radical resection of colorectal cancer in Deyang People ’s Hospital were selected,and divided into control group(n=50) and observation group(n=50) according to the random number table. The control group was given general anesthesia,and on this basis,the observation group was given ultrasound-guided horizontal abdominal block. T he hemodynamics,analgesic effect and adverse reactions were compared between the two groups. Results The mean arterial pressure(MAP) and heart rate(HR) at the time of skin incision,resection of cancer focus and the end of operation,dosage of propofol and sufentanil and the time of opening eyes,extubating trachea and fully awakening,the VAS scores at 2,12,24,48 and 72 hours after operation in observation group were significantly lower than those in control group(P<0.05). The times of analgesia pump and remedial analgesia in observation group were significantly lower than those in control group(P<0.05),but the satisfactory rate of analgesia in observation group was significantly higher than that in control group(96.0% vs 82.0%,χ~2=5.005,P=0.025). There was no significant difference in the incidence of adverse reactions between control group and observation group(10.0% vs 14.0%,χ~2=0.379,P=0.538). Conclusions Ultrasound-guided transverse abdominal planar block combined with general anesthesia can effectively improve the anesthesia effect of patients undergoing laparoscopic radical resection of colorectal cancer,stabilize hemodynamics,reduce dosage of general anesthesia,and has better sefety,which is worthy of clinical promotion and application.

关 键 词：结直肠癌 超声引导 腹横肌平面阻滞 腹腔镜结直肠癌根治术 血流动力学 疼痛 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]