全麻复合超声引导下双侧腹直肌后鞘、腹横肌平面阻滞在超低位直肠癌患者麻醉中的应用分析  

Application Bilateral Posterior Sheath of Rectus Abdominalis and Transverse Abdominalis Plane Block Under General Anesthesia Combined with Ultrasound-guided Anesthesia in Patients with Ultra-low Rectal Cancer

作　　者：张明阳 Zhang Mingyang(Department of Anesthesiology,Nanyang Second General Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市第二人民医院麻醉科,河南南阳473000

出　　处：《黑龙江医学》2024年第19期2311-2314,共4页Heilongjiang Medical Journal

摘　　要：目的:探讨全麻复合超声引导下双侧腹直肌后鞘、腹横肌平面阻滞在超低位直肠癌患者麻醉中的应用效果。方法:选取2021年1月—2023年1月南阳市第二人民医院收治的64例择期拟行开腹结直肠切除术的超低位直肠癌患者作为研究对象,按随机数表法将其分为观察组和对照组,每组各32例。对照组患者采取常规全麻方案,观察组患者采取全麻复合超声引导下双侧腹直肌后鞘、腹横肌平面阻滞麻醉方案。比较两组患者围术期相关指标(镇痛泵按压次数、肛门排气恢复时间、首次下床活动时间)。以术后4 h (T1)、术后8 h (T2)、术后16 h (T3)、术后24 h (T4)为时间节点比较两组患者静息状态、运动状态下疼痛视觉模拟评分(VAS)。比较两组患者不同时间段(术后0~12 h、12~24 h、24~36 h、36~48h)舒芬太尼消耗量。以麻醉前(t0)、术后2 h (t1)、术后24 h (t2)为时间节点比较两组患者免疫功能指标(CD3+、CD4+、CD8+)水平及不良反应发生情况。结果:观察组患者镇痛泵按压次数少于对照组患者,观察组患者肛门排气恢复时间、首次下床活动时间均短于对照组患者,差异均有统计学意义(t=-7.119、-3.277、-14.938,P<0.05)。T1~T3时间段,观察组患者静息状态、运动状态下VAS评分均低于对照组患者,差异均有统计学意义(t=-17.183、-10.620、-14.045、-22.556、-16.659、-24.800,P<0.001)。术后0~12 h、12~24 h,观察组患者舒芬太尼消耗量及总消耗量均低于对照组患者,差异均有统计学意义(t=-33.316、-25.440、-40.104,P<0.001)。t2时间点,观察组患者CD3+、CD4+水平均高于对照组患者,观察组患者CD8+水平均低于对照组患者,差异均有统计学意义(t=3.999、4.128、2.050,P<0.05)。两组患者不良反应总发生率比较,差异无统计学意义(χ^(2)=0.474,P>0.05)。结论:全麻复合超声引导下双侧腹直肌后鞘、腹横肌平面阻滞应用于超低位直肠癌患者麻醉中,可有效提Objective:To investigate the efficacy and safety of bilateral posterior sheath of rectus abdominis,and transverse abdominis plane block under general anesthesia combined with ultrasound-guided anesthesia in patients with ultra-low rectal cancer.Methods:64 patients with ultra-low rectal cancer who were scheduled to receive open colorectal resection in the hospital from January 2021 to January 2023 were selected as research objects,and were divided into observation group and control group according to random number table method,with 32 cases in each group.The control group received conventional anesthesia,and the observation group received general anesthesia plus ultrasound-guided combined anesthesia program of bilateral posterior sheath of rectus abdominis and transversal abdominis plane block.Perioperative indexes(number of analgesic pump compressions,recovery time of anal exhaust,and first time of getting out of bed)were compared between the two groups.4 h(T1),8 h(T2),16 h(T3)and 24 h(T4)were taken as time nodes to compare the visual analog scale(VAS)of pain at resting state and exercise state between the two groups.The consumption of sufentanil was compared between the two groups at different time periods(0~12 h,12~24 h,24~36 h,36~48 h).Before anesthesia(t0),2 h after surgery(t1),24 h after surgery(t2)as time nodes,the immune function indexes(CD3+,CD4+,CD8+)and the occurrence of adverse reactions between the two groups were compared.Results:The number of analgesic pump compressions in observation group was less than that in control group,and the recovery time of anal exhaust and the first time of getting out of bed in observation group were shorter than those in control group,with statistically significant difference(t=-7.119,-3.277,-14.938;P<0.05).From T1 to T3,VAS scores in resting state and exercise state in observation group were lower than those in control group,with statistically significant differences(t=-17.183,-10.620,-14.045,-22.556,-16.659,-24.800;P<0.05).0~12 h,12~24 h after operation the consumptio

关 键 词：全身麻醉 腹直肌后鞘阻滞 腹横肌平面阻滞 超低位直肠癌 

分 类 号：R614.2[医药卫生—麻醉学]