超声引导下RISS平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响  

Influence of ultrasound⁃guided RISS plane block on serum Cor,SP,PGE2 and IL⁃6 in patients with thoracoabdominal surgery

作　　者：张莉莉[1] 杨雅婷 贾倩倩[1] ZHANG Lili;YANG Yating;JIA Qianqian(Department of Anesthesiology,the First Hospital of Qinhuangdao,Qinhuangdao,Hebei,China,066000)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066000

出　　处：《分子诊断与治疗杂志》2024年第5期839-842,847,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河北省医学科学研究课题计划(20201315);秦皇岛市重点研发计划科技支撑项目(202301A269)。

摘　　要：目的 探究超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响。方法 选取2021年1月至2022年7月入住秦皇岛市第一医院接受胸腹部手术的患者126例,按照随机掷硬币法分为观察组和对照组,各63例,两组进行常规麻醉诱导,气管插管后观察组行超声引导下RISS平面阻滞,对照组不行神经阻滞。比较两组术后疼痛视觉模拟(VAS)评分及镇静Ramsay评分、手术麻醉药物用量、围术期血流动力学指标(收缩压、舒张压、心率)及炎症应激指标[皮质醇(Cor)、P物质(SP)、前列腺素E2(PGE2)、白细胞介素-6(IL-6)]水平、不良反应发生情况。结果 手术结束后2 h、12 h、24 h,观察组VAS评分和Ramsay评分均显著低于对照组,差异均有统计学意义(P<0.05);术中及术后24 h,观察组舒芬太尼使用量显著低于对照组,差异有统计学意义(P<0.05);插管后两组收缩压、舒张压和心率均低于插管前,差异有统计学意义(P<0.05),插管后10 min和停药后10 min,观察组收缩压、舒张压心率显著低于对照组,差异有统计学意义(P<0.05);术后两组外周血中Cor、SP、PGE2、IL-6水平均低于术前,差异有统计学意义(P<0.05);术后12 h、24 h,观察组Cor、SP、PGE2、IL-6水平均低于对照组,差异有统计学意义(P<0.05);观察组麻醉不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 超声引导下RISS平面阻滞具有良好镇痛镇静效果,能减轻胸腹部手术患者应激及炎症反应,安全性较高,值得临床应用推广。Objective To explore the influence of ultrasound⁃guided rhomboid intercostal and sub⁃serratus(RISS)plane block on serum Cor,SP,PGE2 and IL⁃6 in patients undergoing thoracoabdominal sur⁃gery.Methods 126 patients who underwent thoracoabdominal surgery at the First Hospital of Qinhuangdao from January 2021 to July 2022 were selected and divided into an observation group and a control group using the random coin⁃tossing method,with 63 cases in each group.Both groups received routine anesthesia induc⁃tion.Following tracheal intubation,the observation group was received ultrasound⁃guided RISS plane block,while the control group did not receive nerve block.Postoperative Visual Analogue Scale(VAS)scores,seda⁃tion Ramsay scores,dosage of anesthesia drugs,perioperative hemodynamic indicators(systolic blood pres⁃sure,diastolic blood pressure,heart rate),and inflammatory stress indicators[cortisol(Cor),substance P(SP),prostaglandin E2(PGE2),interleukin⁃6(IL⁃6)]and occurrence of adverse reactions were compared between the two groups of patients.Results At 2,12,and 24 hours after the end of treatment,the VAS score and Ramsay score in the observation group were significantly lower than those in the control group(P<0.05).During surgery and 24 hours after surgery,the dosage of sufentanil in the observation group was signifi⁃cantly less than that in the control group(P<0.05).The systolic blood pressure,diastolic blood pressure,and heart rate were lower after intubation than before intubation(P<0.05).At 10 minutes after intubation and 10 minutes after drug withdrawal,the systolic blood pressure,diastolic pressure,and heart rate in the observation group were significantly lower than those in the control group(P<0.05).The levels of Cor,SP,PGE2,and IL⁃6 in peripheral blood of both groups after surgery were lower than before surgery(P<0.05).The levels of Cor,SP,PGE2,and IL⁃6 in the observation group were lower than those in the control group at 12 and 24 hours after surgery(P<0.05).The total incidence of pos

关 键 词：超声引导 平面阻滞 疼痛指数 心率 舒芬太尼 胸腹腔手术 

分 类 号：R614[医药卫生—麻醉学]