腹横肌平面阻滞对结直肠肿瘤患者术后快速康复的影响

Effect of transversus abdominis plane block on postoperative recovery in patients undergoing colorectal tum or resection

目的观察腹横肌平面阻滞对结直肠肿瘤患者快速康复的影响。方法将60例行择期腹腔镜结直肠肿瘤手术的患者按随机数字表法分成腹横肌平面阻滞组(TAP组)和对照组,每组30例。TAP组术后行静脉自控镇痛加双侧腹横肌平面阻滞,对照组行单纯静脉自控镇痛。比较两组患者术中、术后镇痛药物使用量以及术后4、8、12、24h的视觉模拟评分(VAS评分)、术后卧床时间、首次排气时间、导尿管拔除时间、术后住院时间等指标。分别于术前、术后即刻及术后4、12、24h测定血浆IL-6、TNF-α、C反应蛋白(CRP)水平。结果 TAP组患者术后4、8、12、24h的VAS评分均明显低于对照组(均P<0.05)。TAP组患者术后卧床时间、首次排气时间、术后住院时间均明显短于对照组(均P<0.05)。与术前相比,两组患者术后即刻IL-6、TNF-α、CRP水平均明显升高(均P<0.05),TAP组术后4、12、24h IL-6、CRP水平明显低于对照组,术后4、12h TNF-α水平均明显低于对照组(均P<0.05)。结论腹横肌平面阻滞能有效缓解疼痛,减少炎性介质的产生,有益于患者术后快速康复。

Objective To assess the effect of transversus abdominis plane block on postoperative recovery in patients undergoing colorectal cancer resection. Methods Sixty patients undergoing elective laparoscopic colorectal cancer surgery were randomly divided into two groups： 30 patients received intravenous analgesia plus bilateral transversus abdominis plane block （TAP group）, and another 30 patients received intravenous analgesia alone （control group）. The intraoperative and postoperative analgesia drug use and the visual analog score （VAS score） 4h, 8h, 12h and 24h after operation were compared between two groups; the time of bed rest, the first exhaust time, the time of catheter removal, postoperative hospital stay were also documented in two groups. Plasma interleukin-6 （IL-6）, tumor necrosis factor-α（TNF-α） and C reactive protein （CRP） levels were measured before and Oh, 4h, 12h and 24h after surgery. Results The VAS scores in the TAP group at 4, 8,12h and 24 h after surgery were significantly lower than those in control group （P〈0.05）. In the group TAP, the time of bed rest, the first exhaust time, postoperative hospital stay were significantly shorter than those in the control group （P〈0.05）. Compared to those before operation, plasma IL-6, TNF-α and CRP were significantly increased after the operation in both groups （P〈0.05）. however, CRP and IL-6 levels at 4h, 12h, 24h after operation, and TNF-α at 4h, 12h after operation were significantly lower than those in the control group at the corresponding time points（P〈0.05）. Conclusion Transversus abdominis plane block can effec- tively relieve pain and reduce inflammatory mediators, leasing to fast recovery after laparoscopic surgery in patients with colorec- tal cancer.