骶管阻滞与腰麻对肛周感染手术患者胰岛素抵抗的影响

Effect of sacral canal block and lumbar anesthesia on insulin resistance in patients undergoing perianal infection surgery

目的比较超声引导骶管阻滞与腰麻对肛周感染手术患者胰岛素抵抗、促炎细胞因子、术中安全性及术后舒适度的影响,优化肛周手术患者的麻醉策略。方法选取2022年12月至2023年6月深圳市中医肛肠医院收治的120例肛周感染手术患者作为研究对象,根据随机数字表法将其分为Sa组(60例)与Su组(60例),Sa组患者采用超声引导骶管阻滞,Su组患者采用蛛网膜下隙阻滞。比较两组患者在入室时(T_(0))、手术结束时(T_(1))、术后7 h(T_(2))、术后16 h(T_(3))、术后40 h(T_(4))的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血糖(FPG)、胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)的水平,及术中不良事件发生率、术后疼痛评分、术后恶心呕吐评分、术后尿潴留发生率。结果Sa组患者T_(3)时ln(HOMA-IR)低于Su组,差异有统计学意义(P<0.05);Sa组患者T_(3)时TNF-α高于Su组,差异有统计学意义(P<0.05)。Sa组患者T_(4)时动态视觉模拟评分法(VAS)评分低于Su组,差异有统计学意义(P<0.05)。Sa组患者T_(3)和T_(4)时FPG低于本组T_(0)时间点,差异有统计学意义(P<0.05);Sa组患者T_(3)和T_(4)时FINS和ln(HOMA-IR)低于本组T_(0)时间点,差异有统计学意义(P<0.05)。Su组患者T_(3)和T_(4)时ln(HOMA-IR)低于本组T_(0)时,差异有统计学意义(P<0.05)。两组的术中不良事件发生率、术后恶心呕吐评分、术后尿潴留发生率比较,差异无统计学意义(P>0.05)。结论超声引导骶管阻滞减轻肛周感染手术患者胰岛素抵抗的效果优于腰麻,且后遗镇痛效应更持久。

Objective To compare the effect of ultrasound-guided sacral canal block and lumbar anesthesia on insulin resistance,proinflammatory cytokines,intraoperative safety and postoperative comfort in patients undergoing perianal infection surgery,and optimize the anesthesia strategy for patients undergoing perianal surgery.Methods A total of 120 patients with perianal infection treated in Shenzhen TCM Anorectal Hospital from December 2022 to June 2023 were selected as the study objects.They were divided into Sa group(60 cases)and Su group(60 cases)according to random number table method.Patients in Sa group underwent ultrasound-guided sacral canal block,and patients in Su group underwent subarachnoid space block.The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),fasting plasma glucose(FPG),fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)in,and the incidence of intraoperative adverse events,postoperative pain score,postoperative nausea and vomiting score,and postoperative urinary retention rate of patients in the two groups were compared at the time of entry(T_(0)),at the end of surgery(T_(1)),7 h after surgery(T_(2)),16 h after surgery(T_(3)),and 40 h after surgery(T_(4)).Results ln(HOMA-IR)at T_(3)in Sa group was lower than that in Su group,with statistical significance(P<0.05).The TNF-αat T_(3)in Sa group was higher than that in Su group,and the difference was statistically significant(P<0.05).The dynamic visual analogue scale(VAS)score at T_(4)in Sa group was lower than that in Su group,and the difference was statistically significant(P<0.05).FPG at T_(3)and T_(4)in Sa group was lower than that at T_(0) time point in this group,and the difference was statistically significant(P<0.05).FINS and ln(HOMA-IR)at T_(3)and T_(4)in Sa group were lower than those at T_(0),and the differences were statistically significant(P<0.05).ln(HOMA-IR)at T_(3)and T_(4)in Su group was lower than that at T_(0) in this group,and the difference was statistically significant(P<0.05).There were no significant differences in the incidence of adverse events,postoperative nausea and vomiting score and postoperative urinary retention between the two groups(P>0.05).Conclusion The effect of ultrasound-guided sacral canal block on reducing insulin resistance in patients with perianal infection was better than that of lumbar anesthesia,and the analgesic effect was more lasting.