腹横肌平面阻滞对结直肠肿瘤切除术患者术后康复的影响

Effect of transversus abdominis plane block on postoperative rehabilitation of colorectal cancer patients

目的 观察腹横肌平面阻滞（transversus abdominis plane block, TAPB）对结直肠肿瘤切除术患者术后康复的影响。 方法 择期行腹腔镜结直肠肿瘤切除术的患者60例，按随机数字表法分成腹横肌平面阻滞组（TAPB组）和对照组（C组），每组30例。TAPB组术后行双侧TAPB，C组行单纯患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）。比较两组患者术后4、8、12、24 h的VAS评分、术后卧床时间、首次排气时间等指标。分别于术前、术后即刻及术后4、12、24 h测定血浆IL-6、TNF-α、C-反应蛋白（C-reactive protein, CRP）水平。 结果 TAPB组患者术后4、8、12、24 h的VAS评分低于C组（P〈0.05）。TAPB组患者术后卧床时间、首次排气时间短于C组（P〈0.05）。与术前比较，两组患者术后即刻血浆IL-6、TNF-α、CRP水平差异无统计学意义（P〈0.05），但术后4、12、24 h TAPB组血浆TNF？蛳α、IL？蛳6、CRP水平低于C组（P〈0.05）。 结论 TAPB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 evaluate the effect of transversus abdominis plane block（TAPB） on postoperative recovery of patients with colorectal cancer. Methods Sixty patients with colorectal cancer undergoing elective laparoscopic surgery were randomized into two groups （n=30）： transversus abdominis plane block group （group TAPB） and control group （group C）. Patients in group TAP and group C respectively received postoperative TAPB and patient-controlled intravenous analgesia（PCIA）. The VAS scores, bed rest time, and the time of first exhaustion were recorded 4, 8, 12, 24 h after operation. The protein levels of plasma IL-6, TNF-α, and C-reactive protein（CRP） were determined before surgery, immediately after surgery, and 4, 12, 24 h after surgery. Results The VAS scores 4, 8, 12, 24 h after TAPB in group TAPB were significantly lower than those in group C（P〈0.05）. Patients in group TAPB had shorter bed rest time and earlier exhaustion than patients in group C（P〈0.05）. The protein levels of IL-6, TNF-α and CRP in group C did not differ immediately after surgery, but were significantly reduced 4, 12, 24 h after surgery, compared with those in group C （P〈0.05）. Conclusions TAPB can effectively relieve postoperative pain and reduce the production of inflammatory factors, therefore is beneficial for patients＇ postoperative rehabilitation.