超声引导下腹横肌平面阻滞对妇科腹腔镜手术患者预防性镇痛效果及对炎性因子的影响

Effect of Ultrasound‐guided Horizontal Abdominal Muscle Block on Preventive Analgesia and Inflammatory Factors in Patients Undergoing Gynecological Laparoscopic Surgery

[目的]探讨超声引导下腹横肌平面阻滞对妇科腹腔镜手术患者预防性镇痛效果及对炎性因子的影响.[方法]选取本院2016年2月至2018年1月在本院进行妇科腹腔镜手术患者120例,按照随机数表法分为观察组和对照组,每组60例.观察组在麻醉前行超声引导下腹横肌平面阻滞麻醉,对照组在手术结束后行超声引导下腹横肌平面阻滞麻醉,对比两组患者术后不同时间点的视觉模拟评分法(VAS)、镇痛补救率、舒适量表(BCS)评分及炎性因子[肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、白介素2(IL-2)、白介素8(IL-8)]水平及术后感染情况.[结果]观察组患者术后3 h、6 h、12 h、24 h静息及运动VAS评分均显著性低于术后1 h(P<0.05);对照组患者术后各时间点VAS评分比较差异无显著性(P>0.05);观察组术后不同时间点的静息及运动状态的VAS评分均显著低于对照组同期(P<0.01).观察组术后补救率(1.67%)显著低于对照组(11.67%)(P<0.05);术后不同时间点,观察组患者的BCS评分显著低于对照组(P<0.05);观察组患者术后24 h的TNF-α、IL-6、IL-2、IL-8水平均显著低于对照组(P<0.05).[结论]在妇科腹腔镜手术麻醉前采用超声引导下腹横肌平面阻滞,可有效起到预防性镇痛作用,降低术后炎症因子水平,促进妇科腹腔镜手术患者术后康复.

[Objective]To observe the effect of ultrasound‐guided transverse abdominal muscle block on pre‐ventive analgesia and inflammatory factors in patients undergoing gynecological laparoscopic surgery.[Methods]From February 2016 to January 2018,120 patients undergoing gynecological laparoscopic surgery were randomly divided into observation group(n=60)and control group(n=60).The observation group underwent ultra‐sound‐guided abdominal transverse muscle plane block anesthesia before anesthesia,while the control group under‐went ultrasound‐guided abdominal transverse muscle plane block anesthesia after operation.The pain status(pain VAS score),analgesic recovery rate,comfort scale(BCS)score and inflammatory factors(tumor necrosis factor‐α,IL‐6,IL‐2,IL‐8 and postoperative infection)levels of the two groups at different time points were compared.[Results]The rest and exercise VAS scores of the patients in the observation group were significantly lower than 1 h after operation(P<00.5);the VAS scores of the patients in the control group at different time points after op‐eration were significantly lower than those in the control group(P<00.1).The postoperative remediation rate(16.7%)in the observation group was significantly lower than that in the control group(116.7%)(P<00.5);the BCS score in the observation group was significantly lower than that in the control group at different time points after operation(P<00.5);and the TNF‐α、IL‐6、IL‐2、IL‐8 level in the observation group was significantly lower than that in the control group at 24 h after operation(P<00.5).[Conclusion]The use of ultrasound‐guided hori‐zontal abdominal muscle block before anesthesia in gynecological laparoscopic surgery can effectively play a preventive analgesic role,reduce the level of postoperative inflammatory factors,and promote the postoperative rehabili‐tation of gynecological laparoscopic surgery patients.