切口缝合后超声引导腹横肌平面阻滞在腹腔镜直肠癌根治术中的应用

Application of ultrasound-guided transversus abdominis plane block to laparoscopic radical resection of rectal cancer following incision suture

目的探讨切口缝合后超声引导腹横肌平面(TAP)阻滞在腹腔镜直肠癌根治术中的应用效果。方法选择行腹腔镜直肠癌根治术患者80例,采用随机数字表法将患者分为观察组和对照组,每组40例。观察组在切口缝合后行超声引导TAP阻滞,而对照组在超声引导下注入等剂量生理盐水。采用视觉模拟量表(VAS)评估两组患者术后疼痛程度。比较两组患者术后镇痛效果指标、免疫功能指标、应激反应指标和不良反应发生情况。结果观察组术后4 h、8 h、12 h的VAS评分均低于对照组(均P<0.05);观察组的静脉自控镇痛(PCIA)泵按压次数、舒芬太尼总量和背景输注总量均少于对照组(均P<0.05),而感觉阻滞维持时间长于对照组,首次按压PCIA泵时间迟于对照组(均P<0.05)。观察组术后30 min、24 h、48 h的皮质醇和血糖浓度均低于对照组(均P<0.05)。观察组术后第1天和术后第2天的自然杀伤细胞、CD4+和CD4+/CD8+均高于对照组(均P<0.05)。观察组的不良反应总发生率低于对照组(P<0.05)。结论切口缝合后超声引导TAP阻滞可明显减轻患者术后疼痛、应激反应、免疫功能抑制,降低术后不良反应发生率。

Objective To investigate the efficacy of ultrasound-guided transversus abdominis plane（TAP） block applied to laparoscopic radical resection of rectal cancer following incision suture. Methods Eighty patients with laparoscopic radical resection of rectal cancer were selected and were divided into observation group and control group using random number table,with 40 cases in each group. The observation group underwent ultrasound-guided TAP block following incision suture,while the control group accepted ultrasound-guided injection of normal saline of the same volume. The Visual Analogue Scale（VAS） was used to evaluate the postoperative pain of the patients in both groups. The indicators for postoperative analgesic effects,immune function and stress response as well as the incidence of adverse reactions were compared between the two groups. Results The VAS scores in the observation group were all lower than those in the control group at 4 h,8 h and 12 h after operation（all P〈0. 05）. The frequency of patient-controlled intravenous analgesia（PCIA） pump press,total dose of sufentanil,and total background infusion in the observation group were all less than those in the control group（all P〈0. 05）,However,the duration of sensory block was longer and the time for initial press of PCIA pump was longer in the observation group compared to the controls（all P〈0. 05）. The concentrations of cortisol and blood glucose in the observation group were lower than those in the control group at 30 min,24 h and 48 h after operation（all P〈0. 05）. On the 1 st and 2 nd day after operation,the natural killer（NK）cells count,CD4＋cell count and CD4^＋/CD8^＋in the observation group were all higher than those in the control group（all P〈0. 05）. The total incidence rate of adverse reactions in the observation group was lower than that in the control group（P〈0. 05）. Conclusion Ultrasound-guided TAP block following incision suture can significantly reduce patients＇ postoperative pain,stress response and immune function inhibition as well as decrease the incidence rate of postoperative adverse reactions.