地塞米松对腹腔镜结直肠癌根治术患者腹横肌平面阻滞镇痛效果的影响  

Effect of Dexamethasone on Analgesic Effect of Transversal Plane Block in Patients Undergoing Laparoscopic Radical rResection of Colorectal Cancer

作　　者：廖成群 李增强 詹永堃 章梦超 黄建平 LIAO Chengqun;LI Zengqiang;ZHAN Yongkun;ZHANG Mengchao;HUANG Jianping(Department of Anesthesiology,Shaowu Municipal Hospital,Shaowu,Fujian 354000,China;Department of Anesthesiolo-gy,The First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 354000,China)

机构地区：[1]邵武市立医院麻醉科,福建邵武354000 [2]福建医科大学附属第一医院麻醉科,福州354000

出　　处：《转化医学杂志》2024年第6期939-944,共6页Translational Medicine Journal

基　　金：福建省自然科学基金项目(2023J01563)。

摘　　要：目的探讨地塞米松对腹腔镜结直肠癌根治术患者腹横肌平面阻滞(TAPB)镇痛效果的影响。方法选取2021年5月至2024年3月邵武市立医院收治的120例腹腔镜结直肠癌根治术患者作为研究对象,按照随机数表法分为A组、B组、C组,每组40例。其中A组只接受全身麻醉,B组全身麻醉后在超声引导下行TAPB,C组在B组的基础上加用地塞米松。比较3组围手术期指标(瑞芬太尼用量、首次补救镇痛时间、补救镇痛药物用量)、镇痛效果[疼痛数字评分法(NRS)评分]、炎症指标[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、丙二醛(MDA)]以及不良反应情况。结果A组瑞芬太尼用量、补救镇痛药物用量高于B组和C组,首次补救镇痛时间少于B组和C组,差异有统计学意义(P<0.05)。B组瑞芬太尼用量与C组比较,差异无统计学意义(P>0.05);B组首次补救镇痛时间少于C组,补救镇痛药物用量高于C组,差异有统计学意义(P<0.05)。A组术后2 h、6 h、12 h、24 h、48 h的NRS评分高于B组和C组,差异有统计学意义(P<0.05)。B组术后2h、48 h的NRS评分与C组比较,差异无统计学意义(P>0.05);B组术后6 h、12 h、24 h的NRS评分高于C组,差异有统计学意义(P<0.05)。3组手术前后血清IL-6、TNF-α水平出现了先升高后下降的趋势,术后6 h、24 h血清IL-6、TNF-α水平A组>B组>C组,差异有统计学意义(P<0.05)。3组手术前后血清Cor、NE、MDA水平出现了先升高后下降的趋势,术后6 h、24 h血清Cor、NE、MDA水平:A组>B组>C组,差异有统计学意义(P<0.05)。A组、B组、C组的不良反应发生率比较,无统计差异学意义(P>0.05)。结论静脉注射地塞米松(麻醉诱导前)+全身麻醉后超声引导下行TAPB可提高腹腔镜结直肠癌根治术患者的镇痛效果,减少阿片类药物的消耗,并且可减轻术后炎症反应和应激反应。Objective To investigate the analgesic effect of dexamethasone on transverse abdominal muscle plane block(TAPB)in patients undergoing laparoscopic radical resection for colorectal cancer.Methods 120 patients who underwent laparoscopic radical surgery for colorectal cancer admitted to Shaowu municipal hospital from May 2021 to March 2024 were selected as the study subjects.They were randomly divided into Group A,Group B,and Group C,with 40 patients in each group,using a random number table method.Among them,Group A only received general anesthesia,Group B received TAPB under ultrasound guidance after general anesthesia,and Group C received dexamethasone in addition to Group B.Compare three groups of perioperative indicators(remifentanil dosage,first rescue analgesic time,rescue analgesic drug dosage),analgesic effect(pain numerical scoring system(NRS)scores at different time points),inflammatory indicators[interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)]stress indicators[cortisol(Cor),norepinephrine(NE),malondialdehyde(MDA)],and adverse reactions.Results The dosage of remifentanil and rescue analgesic drugs in Group A was higher than that in Group B and Group C,and the first rescue analgesic time was shorter than that in Group B and Group C,with statistical significance(P<0.05).There was no statistically significant difference in the dosage of remifentanil between Group B and Group C(P>0.05);The first rescue analgesia time in Group B was shorter than that in Group C,and the amount of rescue analgesics used was higher than that in Group C,with a statistically significant difference(P<0.05).The NRS scores of Group A at 2 h,6 h 12 h,24 h,and 48 h after surgery were higher than those of Group B and Group C,and the difference was statistically significant(P<0.05).There was no statistically significant difference in NRS scores between Group B and Group C at 2 and 48 h after surgery(P>0.05);The NRS scores of Group B at 6 h,12 h,and 24 h after surgery were higher than those of Group C,and the difference was statis

关 键 词：腹腔镜结直肠癌根治术 地塞米松 腹横肌平面阻滞 镇痛效果 炎症反应 

分 类 号：R614.2[医药卫生—麻醉学]