超声引导下腹横肌平面阻滞联合舒芬太尼、右美托咪定镇痛对肝部分切除术后患者疼痛因子、应激反应和细胞免疫功能的影响  

Effects of Ultrasound-Guided Transverse Abdominal Muscle Plane Block Combined with Sufentanil and Dexmedetomidine Analgesia on Pain Factors,Stress Response and Cellular Immune Function in Patients after Partial Hepatectomy

作　　者：李瑾[1] 李珊珊 白磊[2] 张蕾[1] 戴庆[1] LI Jin;LI Shan-shan;BAI Lei;ZHANG Lei;DAI Qing(Department of Anesthesiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830000,China;Liver and Laparoscopic Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,83000,China)

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830000 [2]新疆医科大学第一附属医院肝脏·腹腔镜外科,新疆乌鲁木齐830000

出　　处：《现代生物医学进展》2022年第16期3055-3060,共6页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C300)。

摘　　要：目的:探讨超声引导下腹横肌平面阻滞(TAPB)联合舒芬太尼、右美托咪定镇痛对肝部分切除术后患者疼痛因子、应激反应和细胞免疫功能的影响。方法:选择我院2020年4月~2021年8月期间收治的行肝部分切除术的患者70例。根据随机数字表法将患者分为A组(超声引导下TAPB联合舒芬太尼镇痛,35例)和B组(超声引导下TAPB联合舒芬太尼、右美托咪定镇痛,35例),对比两组镇静、镇痛效果,观察两组疼痛因子、应激反应和细胞免疫功能变化,对比两组围术期间不良反应发生率。结果:两组术后12 h、术后24 h、术后48 h视觉模拟评分法(VAS)下降,且B组低于A组(P<0.05)。两组术后12 h、术后24 h、术后48 h Ramsay镇静评分下降,但B组高于A组(P<0.05)。两组术后1 d血清前列腺素E2(PGE2)、血清P物质(SP)、降钙素基因相关肽(CGRP)水平均升高,但B组低于A组(P<0.05)。两组术后1 d血清肾上腺素(E)、皮质醇(Cor)、C反应蛋白(CRP)水平均升高,但B组低于A组(P<0.05)。两组术后1 d CD8~+升高,但B组低于A组;CD3~+、CD4~+、CD4~+/CD8~+下降,但B组高于A组(P<0.05)。两组不良反应发生率对比无统计学差异(P>0.05)。结论:超声引导下TAPB联合舒芬太尼、右美托咪定镇痛用于肝部分切除术后患者,可有效减轻术后疼痛和应激反应,改善机体免疫功能,安全可靠。Objective: To investigate the effects of ultrasound-guided transverse abdominal muscle plane block(TAPB) combined with sufentanil and dexmedetomidine analgesia on pain factors, stress response and cellular immune function in patients after partial hepatectomy. Methods: 70 patients who underwent partial hepatectomy in our hospital from April 2020 to August 2021 were selected. According to the random number table method, the patients were divided into group A(TAPB combined with sufentanil analgesia, 35 cases)and group B(ultrasound-guided TAPB combined with sufentanil and dexmedetomidine analgesia, 35 cases). The sedative and analgesic effects of the two groups were compared, the changes of pain factors, stress response and cellular immune function of the two groups were observed, and the incidence of perioperative adverse reactions of the two groups were compared. Results: The visual pain simulation(VAS) scores of the two groups decreased at 12 h, 24 h and 48 h after operation, and the group B was lower than the group A(P<0.05).Ramsay’s sedation score decreased at 12 h, 24 h and 48 h after operation in the two groups, but the group B was higher than the group A(P<0.05). The levels of serum prostaglandin E2(PGE2), serum substance P(SP) and calcitonin gene-related peptide(CGRP) in two groups at 1 d after operation were increased, but the group B was lower than the group A(P<0.05). The levels of epinephrine(E), cortisol(Cor)and C-reactive protein(CRP) in two groups at 1 d after operation were increased, but the group B was lower than the group A(P<0.05).CD8in two groups at 1d after operation were increased, but the group B was lower than group A. CD3, CD4, CD4/CD8decreased,but group B was higher than group A(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Ultrasound-guided TAPB combined with sufentanil and dexmedetomidine for analgesia in patients after partial hepatectomy can effectively reduce postoperative pain and stress response, imp

关 键 词：超声引导 腹横肌平面阻滞 舒芬太尼 右美托咪定 肝部分切除术 疼痛因子 应激反应 细胞免疫功能 

分 类 号：R735.7[医药卫生—肿瘤] R614[医药卫生—临床医学]