不同入路腰方肌阻滞对胃癌根治患者术后恢复的影响

Effects of different approaches of quadrates lumborum block on postoperative recovery of patients undergoing radical gastrectomy

目的比较超声引导不同入路腰方肌阻滞对腹腔镜胃癌根治患者的术后镇痛效果、细胞免疫功能及早期恢复的影响。方法择期行腹腔镜胃癌根治术患者120例,随机分为Q1组(QLB1)、Q2组(QLB2)、Q3组(QLB3)、C组(空白对照),每组30例。四组均采用相同全麻方案复合不同入路的超声引导双侧腰方肌阻滞。记录术后0、6、12、24、48 h时刻静息和动态视觉模拟(VAS)评分,术后48 h内补救性镇痛药物使用量,围术期舒芬太尼使用总量;检测T0(术前即刻)、T1(术后24 h)、T2(术后48 h)时刻T细胞亚群水平;记录术后首次下床时间、首次排气时间、术后住院天数及术后不良反应发生率。结果除术后48 h外,四组其余时刻VAS评分比较,静息:Q2组<Q1组<C组(P<0.05),Q3组<Q1组<C组(P<0.05);动态:Q2组<Q3组<Q1组<C组(P<0.05)。术后48 h内补救性镇痛药物使用量比较:Q2组<其余三组(P<0.05)。围术期舒芬太尼使用总量比较:C组>其余三组(P<0.05)。四组各组内不同时刻T细胞亚群水平比较:T1<T0(P<0.05),T2<T0(P<0.05)。T1时刻各组CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平比较:C组<Q1组<Q3组<Q2组(P<0.05);T2时刻各组CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平比较:Q1组<Q3组<Q2组(P<0.05),C组<Q3组<Q2组(P<0.05)。术后首次下床时间和首次排气时间比较:Q2组<Q3组<Q1组<C组(P<0.05)。术后住院天数比较:C组>其余三组(P<0.05)。术后不良反应发生率Q2组<C组(P<0.05)。结论超声引导腰方肌阻滞可为腹腔镜胃癌根治患者提供满意的术后镇痛,降低手术对T细胞亚群的影响,减轻机体细胞免疫抑制,加速患者术后康复,利于其转归。其中,QLB2在减轻动态疼痛和细胞免疫抑制方面效果优于QLB1和QLB3。

Objective To compare the effects of quadrates lumborum block via different approaches on postoperative analgesia,cellular immune function and early recovery in patients undergoing laparoscopic radical gastrectomy.Methods A total of 120 patients selected for laparoscopic radical gastrectomy were randomly divided into group Q1(QLB1),group Q2(QLB2),group Q3(QLB3)and group C(blank control),with 30 cases in each group.All groups used the same general anesthesia scheme,but the ultrasound-guided bilateral quadrates lumborum block were through different approaches.The resting and dynamic visual analogue score(VAS)at 0 h,6 h,12 h,24 h and 48 h after operation,use of remedial analgesics within 48 h after operation,and total usage of sufentanil during perioperative period were recoded.The levels of T cell subsets at T0(right before operation),T1(24 h after operation)and T2(48 h after operation)were recorded.The first time out of bed,first exhaust time,postoperative hospitalization days and incidence of adverse reactions were also recorded.Results Except 48 h after operation,comparison of VAS scores of the four groups at other times,the resting VAS score:group Q2<group Q1<group C(P<0.05),group Q3<group Q1<group C(P<0.05);the dynamic VAS score:group Q2<group Q3<group Q1<group C(P<0.05).The use of remedial analgesics within 48 hours after operation was lower in group Q2 than in the other three groups(P<0.05).The total use of sufentanil during perioperative period was higher in group C than in the other three groups(P<0.05).The levels of T cell subsets at different times in four groups:T1<T0(P<0.05),T2<T0(P<0.05).At T1,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+):group C<group Q1<group Q3<group Q2(P<0.05).At T2,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+):group Q1<group Q3<group Q2(P<0.05),group C<group Q3<group Q2(P<0.05).The first time out of bed and first exhaust time:group Q2<group Q3<group Q1<group C(P<0.05).The postoperative hospital stay was longer in group C than in the other three groups(P<0.05).The incidence of adverse reactions was lower in group Q2 than in group C(P<0.05).Conclusions Ultrasound guided lumbar quadratus block can provide satisfactory analgesia for patients after laparoscopic radical gastrectomy,reduce the effects of surgery on T cell subsets and cellular immunosuppression,accelerate the postoperative rehabilitation and facilitate the prognosis.QLB2 is superior to QLB1 and QLB3 in reducing dynamic pain and cellular immunosuppression.