低位SAPB联合全身麻醉对老年上腹部手术患者术后血清CRP、IL-6、PCT水平的影响  

Effect of Low SAPB Combined with General Anesthesia on Serum CRP,IL-6 and PCT Levels in Elderly Patients undergoing Upper Abdominal Surgery

作　　者：李争卫 邓挚玺 LI Zheng-wei;DENG Zhi-xi(Department of Anesthesiology,The First Affiliated Hospital of Xi'an Medical College,Xi'an Shaanxi 710077)

机构地区：[1]西安医学院第一附属医院麻醉科,陕西西安710077 [2]西安市长安医院麻醉科,陕西西安710016

出　　处：《医学临床研究》2022年第11期1640-1643,共4页Journal of Clinical Research

摘　　要：【目的】探讨低位前锯肌平面阻滞(SAPB)联合全身麻醉对老年上腹部手术患者术后血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)水平的影响。【方法】78例择期行上腹部手术的老年患者,随机分为观察组与对照组。对照组患者行全身麻醉,观察组患者于术前30 min在超声引导下行低位SAPB联合全身麻醉。观察并比较两组围术期指标,记录并比较拔管时(T0)、术后4 h(T_(1))、术后8 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))两组患者静息时及咳嗽时疼痛视觉模拟评分(VAS评分);比较两组术中丙泊酚、瑞芬太尼用量及术后24 h镇痛泵使用次数、背景输注总量;比较两组术前及术后1 d,术后2 d患者CRP、IL-6、PCT水平;比较两组不良反应发生情况。【结果】观察组苏醒时间、拔管时间、住院时间与对照组比较,差异均无统计学意义(P>0.05),观察组首次下床时间早于对照组(P<0.05)。T0时两组静息时及咳嗽时VAS疼痛评分比较,差异无统计学意义(P>0.05),T_(1)~T_(4)观察组静息时及咳嗽时VAS评分均显著低于对照组(P<0.05)。观察组术中丙泊酚、瑞芬太尼使用量及术后24 h镇痛泵按压次数、背景输注总量显著低于对照组(P<0.05)。术后1 d、术后2 d观察组CRP、IL-6、PCT水平显著低于对照组(P<0.05)。观察组不良反应总发生率显著低于对照组(P<0.05)。【结论】相较于全身麻醉,SAPB联合全身麻醉对老年上腹部患者的术后镇痛效果更好,对血清CRP、IL-6、PCT水平的影响较小,能够减轻炎症反应,且不良反应发生少,值得临床应用与推广。【Objective】To investigate the effects of serratus anterior plane block(SAPB)combined with general anesthesia on serum C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)levels in elderly patients undergoing upper abdominal surgery.【Methods】A total of 78 elderly patients who were selected for upper abdominal surgery were randomly divided into the observation group and the control group.The patients in the control group received general anesthesia,while patients in the observation group received low SAPB combined general anesthesia under ultrasound guidance 30 minutes before operation.The perioperative indexes of the two groups were observed and compared,and the visual analogue score(VAS)scores of pain at rest and during cough of patients in the two groups at the time of extubation(T0),4 hours after operation(T_(1)),8 hours after operation(T_(2)),12 hours after operation(T_(3)),and 24 hours after operation(T_(4))were recorded and compared.The dosage of propofol and remifentanil during operation,the number of analgesic pumps used 24 hours after operation,and the total amount of background infusion were recorded and compared between the two groups.The levels of CRP,IL-6 and PCT were compared between the two groups before operation,1 day after operation and 2 days after operation.The adverse reactions of the two groups were compared as well.【Results】There was no significant difference between the observation group and the control group in terms of recovery time,extubation time and length of hospitalization(P>0.05).The first time of getting out of bed in the observation group was significantly shorter than that in the control group(P<0.05).At T0,there was no significant difference in VAS scores between the two groups at rest and during cough(P>0.05).The VAS pain scores at T_(1)-T_(4) in the observation group at rest and during cough were significantly lower than those in the control group(P<0.05).The amount of propofol and remifentanil used during operation,the number of times of pressing anal

关 键 词：神经肌肉阻滞 麻醉 腹部/外科学 C反应蛋白质 老年人 

分 类 号：R656[医药卫生—外科学]