全麻联合超声引导下腹横筋膜阻滞在肥胖结直肠癌患者中的应用效果  

Effectiveness of General Anesthesia Combined with Ultrasound-Guided Transverse Abdominal Plane Block in Obese Colorectal Cancer Patients

作　　者：刘景景[1] 左智超 胡晓慧 赵志莉 张永强[1] LIU Jingjing;ZUO Zhichao;HU Xiaohui;ZHAO Zhili;ZHANG Yongqiang(Department of Anaesthesia and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院麻醉与围术期医学科,河南新乡453100

出　　处：《河南医学研究》2023年第11期1992-1996,共5页Henan Medical Research

摘　　要：目的探究全麻(GA)联合超声引导下腹横筋膜阻滞(TAPB)在肥胖结直肠癌(CRC)患者中的应用效果。方法选取2019年11月至2022年11月新乡医学院第一附属医院80例肥胖CRC患者,按随机数字表法分成A组(40例)、B组(40例)。B组接受GA,A组接受GA联合超声引导下TAPB。对比两组苏醒质量[自主呼吸时间、麻醉恢复室(PACU)停留时间、呼之睁眼时间]及丙泊酚、瑞芬太尼使用量,对比麻醉前(T_(0))、气管插管时(T_(1))、手术开始10 min(T_(2))、术毕时(T_(3))血流动力学[平均动脉压(MAP)、心率(HR)]、血清血栓素B2(TXB_(2))、6-酮-前列腺素F1α(6-keto-PGF_(1α))水平,比较T_(0)时刻、术后6 h(T_(4))、术后12 h(T_(5))视觉模拟评分法(VAS)评分、应激指标[醛固酮(ALD)、丙二醇(MDA)、皮质醇(Cor)]水平,比较两组不良反应发生率。结果A组PACU停留、自主呼吸、呼之睁眼时间较B组短,丙泊酚及瑞芬太尼使用量较B组少(P<0.05);T_(2)、T_(3)时刻A组HR、MAP水平较B组低(P<0.05);A组T_(4)、T_(5)时刻VAS评分较B组低(P<0.05);A组T_(1)、T_(2)、T_(3)时刻血清TXB_(2)水平较B组低,6-keto-PGF_(1α)水平较B组高(P<0.05);A组T_(4)、T_(5)时刻血清ALD、Cor、MDA水平较B组低(P<0.05);A组不良反应发生率[2.50%(1/40)]较B组[20.00%(8/40)]低(P<0.05)。结论CRC患者在GA基础上联合应用超声引导下TAPB麻醉可提升苏醒质量,减少丙泊酚、瑞芬太尼使用量,减轻疼痛感,维持术中血流动力学及TXB_(2)/6-keto-PGF_(1α)动态平衡,对机体循环应激及血小板功能影响小,安全性更高。Objective To investigate the effect of general anesthesia(GA)combined with and ultrasound-guided transverse abdominal plane block(TAPB)in obese patients with colorectal cancer(CRC).Methods Eighty obese CRC patients treated in the First Affiliated Hospital of Xinxiang Medical College from November 2019 to November 2022 were selected and divided into group A(40 cases)and group B(40 cases)by random number table method.Group B received GA and Group A received GA combined with ultrasound-guided TAPB.The quality of awakening[time to spontaneous breathing,postanesthesia care unit(PACU),time to open eyes at exhalation],propofol and remifentanil use were compared between the two groups.Hemodynamics[mean arterial pressure(MAP),heart rate(HR)],serum thromboxane B 2(TXB_(2)),6-keto-prostaglandin F 1α(6-keto-PGF_(1α))levels were compared between the two groups before anesthesia(T_(0)),at the time of tracheal intubation(T_(1)),10 minutes after the start of surgery(T_(2)),at the end of surgery(T_(3)).Visual analogue scale(VAS),stress indicators[aldosterone(ALD),propylene glycol(MDA),cortisol(Cor)]levels at T_(0)moment,6 hours after surgery(T_(4))and 12 hours postoperative(T_(5))and incidence of adverse reactions were compared between the two groups.Results Group A had shorter PACU stay,spontaneous breathing and eye opening time of exhalation than group B,and used less propofol and remifentanil than group B(P<0.05).Group A had lower HR and MAP levels at T_(2)and T_(3)than group B(P<0.05).Group A had lower VAS scores at T_(4)and T_(5)than group B(P<0.05).Serum TXB_(2)levels were lower and 6-keto-PGF_(1α)levels were higher in group A than those in group B at T_(1),T_(2)and T_(3)(P<0.05).Serum ALD,Cor and MDA levels were lower in group A than those in group B at T_(4)and T_(5)(P<0.05).The incidence of adverse reactions in group A[2.50%(1/40)]was lower than that[20.00%(8/40)]in group B(P<0.05).Conclusion Combined application of GA and ultrasound-guided TAPB anesthesia in CRC patients based on GA can improve the quality of awakeni

关 键 词：肥胖结直肠癌 循环应激 苏醒质量 

分 类 号：R614.2[医药卫生—麻醉学]