腹横肌平面阻滞联合全凭静脉麻醉对卵巢癌手术患者血流动力学、免疫功能、应激反应的影响  

Effect of abdominal transverse muscle plane block combined with total intravenous anesthesia on hemodynamics,immune function,and stress response in patients undergoing ovarian cancer surgery

作　　者：陈皎[1] 郑春梅 李雄海 岳丽娟[2] 武辉 CHEN Jiao;ZHENG Chunmei;LI Xionghai;YUE Lijuan;WU Hui(Department of Laboratory,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,China;Department Oncology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,China;Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,China)

机构地区：[1]汉中市中心医院检验科,陕西汉中723000 [2]汉中市中心医院肿瘤科,陕西汉中723000 [3]汉中市中心医院麻醉科,陕西汉中723000

出　　处：《癌症进展》2023年第16期1797-1800,1827,共5页Oncology Progress

基　　金：陕西省重点研发计划项目(2017SF-074)。

摘　　要：目的探讨腹横肌平面阻滞联合全凭静脉麻醉对卵巢癌手术患者血流动力学、免疫功能、应激反应的影响。方法依据麻醉方法的不同将180例卵巢癌患者分为观察组和对照组,每组90例,对照组患者给予硬膜外阻滞联合全凭静脉麻醉,观察组患者给予腹横肌平面阻滞联合全凭静脉麻醉。比较两组患者的术后恢复指标、疼痛程度[视觉模拟评分法(VAS)]、血流动力学指标[血氧饱和度(SpO_(2))、心率及收缩压]、免疫功能指标[CD3^(+)、CD4^(+)、自然杀伤(NK)细胞]、应激反应指标[皮质醇、前列腺素E_(2)(PGE_(2))]和并发症发生情况。结果两组患者首次下床时间、首次排气时间和住院时间比较,差异均无统计学意义(P﹥0.05)。术后2、6、12、24、48 h,观察组患者的VAS评分均明显低于对照组,差异均有统计学意义(P﹤0.01)。气管插管时(T_(1))、术毕(T_(2))时,对照组患者心率、收缩压均低于本组T_(0)时和观察组,差异均有统计学意义(P﹤0.05);T_(1)、T_(2)时,观察组患者心率、收缩压与本组麻醉前(T_(0))时比较,差异均无统计学意义(P﹥0.05)。术后1天,两组患者CD3^(+)、CD4^(+)、NK细胞水平均低于本组术前,皮质醇、PGE_(2)水平均高于本组术前,观察组患者CD3^(+)、CD4^(+)、NK细胞水平均高于对照组,皮质醇、PGE_(2)水平均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者低血压、下肢感觉异常发生率均低于对照组,差异均有统计学意义(P﹤0.05)。结论腹横肌平面阻滞联合全凭静脉麻醉可有效改善卵巢癌手术患者的术后疼痛程度,维持血流动力学稳定,减轻免疫抑制及应激反应,值得临床推广。Objective To explore the effect of abdominal transverse muscle plane block combined with total intravenous anesthesia on hemodynamics,immune function,and stress response in patients undergoing ovarian cancer surgery.Method A total of 180 patients with ovarian cancer were selected and divided into control group(n=90,received epidural block+total intravenous anesthesia)and observation group(n=90,received abdominal transverse muscle plane block+total intravenous anesthesia)according to different anesthesia methods.The postoperative recovery indexes,pain degree[visual analogue scale(VAS)],hemodynamic indexes[pulse saturation of blood oxygen(SpO_(2)),heart rate and systolic blood pressure],immune function indexes[CD3^(+),CD4^(+),natural killer(NK)cell],stress response indexes[cortisol,prostaglandin E_(2)(PGE_(2))]and complications were compared between the two groups.Result There were no statistically significant differences in the first time of getting out of bed,first exhaust time,and hospitalization time between the two groups of patients(P>0.05).At 2,6,12,24,and 48 h after operation,the VAS scores in the observation group were lower than those in the control group(P<0.01).At the time of endotracheal intubation(T_(1))and after the operation(T_(2)),the heart rate and systolic blood pressure of the control group were lower than those of T_(0) and observation group(P<0.05).At T_(1) and T_(2),there were no statistically significant differences in heart rate and systolic blood pressure between the observation group and before anesthesia(T_(0))in this group(P>0.05).One day after surgery,the levels of CD3^(+),CD4^(+)and NK cells in the two groups were lower than those before the surgery,and cortisol and PGE_(2) were higher than those before the surgery,the levels of CD3^(+),CD4^(+),and NK cells in the observation group were higher than those in the control group,while the levels of cortisol and PGE_(2) were lower than those in the control group,the differences were statistically significant(P<0.05).The incidence of hypote

关 键 词：腹横肌平面阻滞 全凭静脉麻醉 卵巢癌 免疫功能 应激反应 硬膜外阻滞 

分 类 号：R737.31[医药卫生—肿瘤]