B超引导下右美托咪定TAP阻滞对结直肠癌腹腔镜根治术后疼痛和炎症指标水平的影响

Influence of dexmedetomidine TAP block guided by B ultrasound on pain and inflammatory markers after laparoscopic radical resection of colorectal cancer

目的探讨B超引导下右美托咪定腹横肌平面(TAP)阻滞对结直肠癌腹腔镜根治术后疼痛和炎症指标水平的影响。方法选取2015年10月~2017年8月本院收治的拟行腹腔镜根治术的102例结直肠癌患者,随机分为试验组及对照组,各51例。均于手术开始前在B超引导下行双侧TAP阻滞,其中对照组给予0.25%罗哌卡因共40 ml,试验组另给予右美托咪定1.0μg/kg。对比术后12 h及24 h患者疼痛情况,并检测术前及术后24 h的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-10(IL-10)水平,且比较两组术后24 h并发症发生情况。结果试验组术后12 h及24 h的VAS评分均明显低于对照组(P<0.05);两组术后24 h的血清TNF-α、IL-6及IL-10水平均明显高于术前(P<0.05),但试验组术后24 h血清TNF-α、IL-6均明显低于对照组(P<0.05),而IL-10水平均明显高于对照组(P<0.05);两组术后24 h低血压、呼吸抑制及尿潴留发生率比较差异均无统计学意义,但试验组心动过缓发生率明显高于对照组(P<0.05)。结论 B超引导下右美托咪定TAP阻滞可显著降低结直肠癌腹腔镜根治术后患者疼痛感,并抑制促炎因子释放,且可促进抗炎因子分泌,但其可增加发生心动过缓的风险,需在临床使用中加强对患者的监测。

Objective To investigate the influence of dexmedetomidine transversus abdominis plane(TAP)block guided by B ultrasound on pain and inflammation marker levels after laparoscopic radical resection of colorectal cancer.Methods 102 patients of colorectal cancer would be treated with laparoscopic radical mastectomy were selected from October 2015 to August 2017 in our hospital,who were randomly divided into experimentation group and control group,and there were 51 cases in each group.All patients were given bilateral TAP block under B ultrasound guidance before operation,between which the control group was given total 40 ml of 0.25%ropivacaine,while the experimentation group was given dexmedetomidine 1.0μg/kg on the base of the control group.The pain degrees after 12 h and 24 h of operation were compared,and the levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)were detected before and after 24 h of operation,then the incidence of postoperative complications in the two groups after 24 h of operation were compared.Results The VAS scores after 12 h and 24 h of operation in the experimentation group were significantly lower than those of the control group(P<0.05).The levels of serum TNF-α,IL-6 and IL-10 of the two groups after 24 h of operation were significantly higher than those before operation(P<0.05),but the levels of serum TNF-αand IL-6 of the experimentation group after 24 h of operation were significantly lower than those of the control group(P<0.05),while the level of serum IL-10 of the experimentation group after 24 h of operation was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of hypotension,respiratory depression and urinary retention between the two groups after 24 h of operation,but the rate of bradycardia of the experimentation group was significantly higher than that of the control group(P<0.05).Conclusion Dexmedetomidine TAP block guided by B ultrasound can significantly reduce pain of patients with colorectal cancer after laparoscopic radical surgery,inhibit pro-inflammatory factors release,and promote anti-inflammatory factors secretion,but it can increase the risk of bradycardia,so it is necessary to strengthen the monitoring of patients in clinical use.