不同区域神经阻滞方案在老年直肠癌手术患者中应用效果的比较  

Comparision of application effect of different regional nerve block programs in elderly patients undergoing rectal cancer surgery

作　　者：王桂飞 苏光磊 任俊明[1] 毕竞 WANG Guifei;SU Guanglei;REN Junming;BI Jing(Department of Anesthesiology,Shanxi Provincial People’s Hospital,Taiyuan 030000,Shanxi,China)

机构地区：[1]山西省人民医院麻醉科,太原0300000

出　　处：《癌症进展》2024年第17期1900-1902,1907,共4页Oncology Progress

基　　金：山西省基础研究计划项目(202203021212073)。

摘　　要：目的比较超声引导下腹横肌平面阻滞(TAPB)和腰方肌阻滞(QLB)方案在老年直肠癌手术患者中的应用效果。方法将92例行腹腔镜直肠癌根治术的老年直肠癌患者根据区域神经阻滞方案的不同分为QLB组(n=44,超声引导下QLB方案)和TAPB组(n=48,超声引导下TAPB方案)。比较两组患者术后舒芬太尼总用量、术后恢复情况、血清学指标[5-羟色胺(5-HT)、前列腺素E_(2)(PGE_(2))]及不良反应发生情况。结果术后2、6、12、24 h,QLB组患者舒芬太尼总用量均低于TAPB组,差异均有统计学意义(P﹤0.05)。QLB组患者术后苏醒时间、首次下床时间及首次肛门排气时间均短于TAPB组,不良反应总发生率低于TAPB组,差异均有统计学意义(P﹤0.05)。术后24 h,两组患者血清PGE_(2)、5-HT水平均高于本组术前,QLB组患者血清PGE_(2)、5-HT水平均低于TAPB组,差异均有统计学意义(P﹤0.05)。结论超声引导下QLB应用于腹腔镜直肠癌根治术患者中,能减少术后舒芬太尼用量,促进患者术后恢复,减轻术后疼痛,降低不良反应发生率。Objective To compare the application effect of ultrasound-guided transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)in elderly patients undergoing rectal cancer surgery.Method A total of 92 elderly patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer were divided into QLB group(n=44,ultrasound-guided QLB program)and TAPB group(n=48,ultrasound-guided TAPB program)according to different regional nerve block programs.The postoperative total dosage of sufentanil,postoperative recovery,serological indexes[5-hydroxytryptamine(5-HT),prostaglandin E_(2)(PGE_(2))]and incidence of adverse reactions were compared between the two groups.Result At 2,6,12 and 24 h after operation,the total dosage of sufentanil in QLB group were lower than those in TAPB group,and the differences were statistically significant(P<0.05).The postoperative recovery time,first time of getting out of bed and first time of anal exhaust in QLB group were shorter than those in TAPB group,the total incidence of adverse reactions was lower than that in TAPB group,and the differences were statistically significant(P<0.05).At 24 h after operation,the serum PGE_(2) and 5-HT levels in two groups were higher than those before operation,the serum PGE_(2) and 5-HT levels in QLB group were lower than those in TAPB group,and the differences were statistically significant(P<0.05).Conclusion The application of ultrasound-guided QLB in patients undergoing laparoscopic radical resection of rectal cancer can reduce postoperative sufentanil dosage,promote postoperative recovery,alleviate postoperative pain,and reduce the incidence of adverse reactions.

关 键 词：腹腔镜直肠癌根治术 腰方肌阻滞 腹横肌平面阻滞 

分 类 号：R735.37[医药卫生—肿瘤]