结直肠癌腹腔镜手术患者超声引导下不同浓度罗哌卡因腰方肌阻滞的围术期镇痛效果及T淋巴细胞亚群变化  

Perioperative analgesia and T lymphocyte subsets of ultrasound-guided lumbar quadratus block with different concentrations of ropivacaine before anesthesia induction in patients undergoing laparoscopic surgery for colorectal cancer

作　　者：卢钊楷 刘卫锋 陈醒霞 陈怀佳 LU Zhaokai;LIU Weifeng;CHEN Xingxia;CHEN Huaijia(Department of Anesthesiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;不详)

机构地区：[1]南方医科大学南方医院麻醉科,广州510515 [2]广东医科大学附属东莞厚街医院麻醉科

出　　处：《山东医药》2021年第33期34-39,共6页Shandong Medical Journal

基　　金：南方医科大学南方医院院长基金(2017B015)。

摘　　要：目的观察结直肠癌腹腔镜手术患者麻醉诱导前超声引导下不同浓度罗哌卡因腰方肌阻滞的围术期镇痛效果及T淋巴细胞亚群的变化。方法接受结直肠癌腹腔镜手术治疗的患者60例,随机分为H组、M组、L组,每组20例,三组患者均在超声引导下进行罗哌卡因双侧腰方肌阻滞,罗哌卡因浓度分别为0.5%、0.375%、0.25%,完成腰方肌阻滞后进行全身麻醉、腹腔镜手术治疗及随访。观察术后2、6、12、24、48 h的静息时、运动时VAS评分和术后镇痛泵首次按压时间、舒芬太尼用量、镇痛满意度评分等围术期镇痛指标。观察术中用药量(丙泊酚用量、瑞芬太尼用量)、首次排气时间、首次下地时间、总住院时间等手术相关指标。观察入室时(T0)、开始切皮时(T1)、切除肿瘤时(T2)及拔除气管导管时(T3)的血流动力学指标平均动脉压(MAP)及心率(HR)。观察术后6、12、24、48 h时的T淋巴细胞亚群中CD3^(+)比例、CD4^(+)比例、CD8^(+)比例及CD4^(+)/CD8^(+)。观察恶心呕吐、下肢运动阻滞、皮肤瘙痒、尿潴留和感觉减退等不良反应发生情况。结果三组患者术后6、12、24、48 h的静息时、运动时VAS评分与术后2 h相比均显著升高(P均<0.05),M组、H组患者在术后6、12、24 h的静息时、运动时VAS评分与L组相比均显著降低(P均<0.05),M组、H组患者在术后48 h的运动时VAS评分与L组相比均显著降低(P均<0.05)。M组、H组患者瑞芬太尼用量、丙泊酚用量、舒芬太尼用量与L组相比均显著降低(P均<0.05),镇痛泵首次按压时间、镇痛满意度评分与L组相比均显著升高(P均<0.05)。三组患者MAP、HR在T1、T2时与T0时相比均显著升高(P均<0.05),M组、H组患者在T1、T2时MAP、HR与L组相比均显著降低(P均<0.05)。三组患者术后12、24、48h的T淋巴细胞亚群中CD3^(+)比例、CD4^(+)比例、CD4^(+)/CD8^(+)与术后6 h相比均显著升高(P均<0.05),M组、H组患者术后12 h的T淋�Objective To observe the perioperative analgesic effect and the changes of T lymphocyte subsets of ultrasound-guided lumbar quadratus block with different concentrations of ropivacaine before anesthesia induction in patients undergoing laparoscopic surgery for colorectal cancer.Methods Sixty patients with colorectal cancer undergoing laparoscopic surgery were randomly divided into group H,group M and group L,with 20 patients in each group.All patients in the three groups underwent ultrasound-guided lumbar quadratus block with ropivacaine.The concentrations of ropivacaine were 0.5%,0.375%,and 0.25%,respectively.After completing lumbar quadratus block,they were treated with general anesthesia,laparoscopic surgery and follow-up.The VAS scores at 2,6,12,24 and 48 h after operation at rest and at exercise each,the first pressing time of postoperative analgesic pump,the dosage of sufentanil and the score of analgesic satisfaction were observed.The intraoperative dosage(propofol dosage,remifentanil dosage),the first exhaust time,the first time to the ground,the total hospital stay and other related indexes were observed.The hemodynamic indexes,mean arterial pressure(MAP)and heart rate(HR)were observed at the time points of entering the room(T0),starting skin incision(T1),tumor resection(T2)and tracheal catheter extraction(T3).The proportions of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in T lymphocyte subsets were observed at 6,12,24 and 48 h after operation.Nausea and vomiting,lower limb movement block,pruritus,urinary retention and sensory deterioration were observed.Results The VAS scores at 6,12,24 and 48 h after operation at rest and at exercise each in the three groups were significantly higher than those at 2 h after operation(all P<0.05),the VAS scores at rest and exercise at 6,12 and 24 h after operation in the group M and group H were significantly lower than those in the group L(all P<0.05),and the VAS scores at 48 h after operation at exercise in the group M and group H were significantly lower than those in

关 键 词：局部麻醉药物 罗哌卡因 结直肠癌 超声引导 腰方肌阻滞 腹腔镜手术 T淋巴细胞亚群 围术期镇痛 

分 类 号：R735.37[医药卫生—肿瘤]