超声引导下腹横肌平面阻滞与腰方肌阻滞对子宫肌瘤患者术后免疫功能和术后疲劳综合征的影响  

Effects of ultrasound-guided transversus abdominis plane block and quadratus lumborum block on postoperative immune function and postoperative fatigue syndrome in patients with uterine fibroids

作　　者：陈勇杰[1] 沈晶[1] 李响 陈益君[1] CHEN Yong-jie;SHEN Jing;LI Xiang;CHEN Yi-jun(Department of Anesthesiology,the First Hospital of Ningbo City,Ningbo,Zhejiang 315000,China)

机构地区：[1]宁波市第一医院麻醉科,浙江宁波315000

出　　处：《中国妇幼保健》2024年第15期2970-2974,共5页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2020KY816)。

摘　　要：目的 对比超声引导下腹横肌平面阻滞与腰方肌阻滞对子宫肌瘤患者术后免疫功能和术后疲劳综合征的影响。方法 选取2021年9月-2022年9月在宁波市第一医院行子宫肌瘤手术的70例患者,按照随机数字表法分为对照组35例和研究组35例。对照组患者采用超声引导下腹横肌平面阻滞联合全身麻醉,研究组患者采用超声引导下腰方肌阻滞联合全身麻醉。检测和对比两组患者心率(HR)、平均动脉压(MAP)、免疫功能、应激反应指标、术后疲劳综合征、视觉模拟评分法(VAS评分)、Ramsay镇静评分及并发症发生情况。结果 手术结束1、12 h时,与对照组比较,研究组HR、MAP、皮质醇(COR)、血糖(GLU)、疲劳评分较低,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)比值较高(均P<0.05)。与对照组相比,研究组术后疲劳综合征发生率(22.86%vs. 5.71%)显著降低,术后2 h[(3.45±0.64)分vs.(1.62±0.30)分]、4 h[(3.93±0.73)分vs.(1.83±0.36)分]、8 h[(4.37±0.85)分vs.(2.15±0.54)分]、12 h[(4.94±0.93)分vs.(2.46±0.59)分]VAS评分较低,Ramsay镇静评分[(1.83±0.31)分vs.(2.79±0.42)分、(1.65±0.26)分vs.(2.62±0.38)分、(1.53±0.22)分vs.(2.43±0.31)分、(1.41±0.17)分vs.(2.15±0.28)分]较高(均P<0.05)。与对照组相比,研究组患者并发症发生率(34.29%vs. 11.43%)较低(χ^(2)=5.185,P<0.05)。结论 子宫肌瘤手术患者应用超声引导下腰方肌阻滞联合全身麻醉可以更好地调节免疫功能,缓解应激反应,减轻术后疲劳综合征,加快患者术后恢复。Objective To compare the effects of ultrasound-guided transversus abdominis plane block and quadratus lumborum block on postoperative immune function and postoperative fatigue syndrome in patients with uterine fibroids.Methods Seventy patients undergoing uterine fibroids surgery in the First Hospital of Ningbo City from September 2021 to September 2022 were selected and divided into control group(35 cases)and study group(35 cases).The patients in control group were given ultrasound-guided transversus abdominal plane block combined with general anesthesia,and the patients in study group were given ultrasound-guided quadratus lumborum block combined with general anesthesia.Heart rate(HR),mean arterial pressure(MAP),immune function indexes,stress response,postoperative fatigue syndrome,visual analogue scale(VAS)score,Ramsay sedation score,and complications were detected and compared between the two groups.Results At 1 and 12 hours after operation,compared with control group,HR,MAP,cortisol(COR),glucose(GLU),and fatigue score were lower,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)ratio were higher(P<0.05).Compared with control group,the incidence rate of postop-erative fatigue syndrome in study group(22.86%vs.5.71%)decreased significantly,VAS scores at 2 hours[(3.45±0.64)vs.(1.62±0.30)],4 hours[(3.93±0.73)vs.(1.83±0.36)],8 hours[(4.37±0.85)vs.(2.15±0.54)],and 12 hours[(4.94±0.93)vs.(2.46±0.59)]were lower,Ramsay sedation scores at 2,4,8,and 12 hours[(1.83±0.31)vs.(2.79±0.42),(1.65±0.26)vs.(2.62±0.38),(1.53±0.22)vs.(2.43±0.31),(1.41±0.17)vs.(2.15±0.28)]were higher(P<0.05).Compared with control group,the incidence rate of complications in study group(34.29%vs.11.43%)was lower(x^(2)=5.185,P<0.05).Conclu-sion Ultrasound-guided quadratus lumbar block combined with general anesthesia can better regulate immune function,relieve stress re-sponse,reduce postoperative fatigue syndrome,and speed up postoperative recovery in patients undergoing uterine fibroids surgery.

关 键 词：子宫肌瘤 超声 腹横肌平面阻滞 腰方肌阻滞 免疫功能 术后疲劳综合征 

分 类 号：R711.74[医药卫生—妇产科学]