超声引导下腹直肌鞘阻滞联合羟考酮低背景剂量患者静脉自控镇痛对老年胃癌患者根治术后镇痛效果、免疫功能和应激反应的影响

Effects of ultrasound-guided rectus sheath block combined with low background dose of oxycodone patient controlled intravenous analgesia on postoperative analgesia,immune function and stress response in elderly patients with gastric cancer

目的分析超声引导下腹直肌鞘阻滞(rectus sheath block,RSB)联合羟考酮低背景剂量患者静脉自控镇痛(patient controlled intravenous analgesia,PCIA)对老年患者胃癌根治术后镇痛效果、免疫功能和应激反应的影响。方法选取2016年3月至2019年3月延安大学附属医院收治的92例老年胃癌患者为研究对象,采用随机数字表法将其分为观察组和对照组,每组各46例,均行腹腔镜下胃癌根治术治疗,术后给予羟考酮PCIA,观察组患者在此基础上联合超声引导下RSB。比较两组患者术后视觉模拟评分法(visual analogue scale,VAS)评分、T细胞亚群和应激指标水平、镇痛效果和不良反应发生情况。结果两组患者术后8 h和12 h VAS评分均显著高于本组术后4 h(均P<0.05),术后48 h VAS评分均显著低于本组术后4 h(均P<0.05)。观察组患者术后4 h、8 h、12 h、24 h VAS评分均显著低于同期对照组(均P<0.05)。两组患者术后24 h和72 h CD3+T细胞、CD4+T细胞、CD8+T细胞水平和CD4+T细胞/CD8+T细胞比值均显著低于本组术前10 min(均P<0.05),血清皮质醇(cortisol,Cor)、儿茶酚胺(catecholamine,CA)和血浆谷氨酸(glutamate,Glu)水平均显著高于本组术前10 min(均P<0.05);观察组患者术后24 h和72 h CD3+T细胞、CD4+T细胞、CD8+T细胞水平和CD4+T细胞/CD8+T细胞比值均显著高于同期对照组(均P<0.05),血清Cor、CA和血浆Glu水平均显著低于同期对照组(均P<0.05)。观察组患者镇痛泵按压次数、羟考酮用量均显著少于对照组(均P<0.05),术后肛门排气时间和下床活动时间均显著早于对照组(均P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论羟考酮低背景剂量PCIA应用于老年胃癌根治术后镇痛具有良好的效果及安全性,联合RSB能够进一步提高镇痛效果,减轻手术对患者免疫功能和应激反应的影响。

Objective To analyze the effect of ultrasound-guided rectus sheath block(RSB)combined with low background dose of oxycodone patient controlled intravenous analgesia(PCIA)on postoperative analgesia,immune function and stress response in elderly patients with gastric cancer.Method A total of 92 elderly patients with gastric cancer admitted to Yan'an University Affiliated Hospital from March 2016 to March 2019 were randomly divided into observation group and control group,46 cases in each group.All patients underwent laparoscopic radical gastrectomy,PCIA was given after operation,and ultrasound-guided RSB was used in observation group.The changes of visual analogue scale(VAS)scores,T cell subsets and stress indexes levels,the analgesic effects and adverse reactions were compared between the two groups.Result The VAS scores of the two groups of patients at 8 h and 12 h after operation were significantly higher than those at 4 h after operation(all P<0.05),and the VAS scores at 48 h after operation were significantly lower than those at 4 h after operation(all P<0.05).The VAS scores of observation group were significantly lower than those in control group at 4 h,8 h,12 h and 24 h after operation(all P<0.05).The levels of CD3+T cells,CD4+T cells,CD8+T cells and the ratio of CD4+T cells/CD8+T cells were significantly lower in the two groups 24 h and 72 h after operation than those at 10 min before operation(all P<0.05),and the levels of serum cortisol(Cor),catecholamine(CA)and plasma glutamate acid(Glu)were signi ficantly higher than those at 10 min before operation(all P<0.05).The levels of CD3+T cells,CD4+T cells,CD8+T cells and the ratio of CD4+T cells/CD8+T cells in observation group were significantly higher than those in control group at 24 h and 72 h after oper ation(all P<0.05),and the levels of serum Cor,CA and plasma Glu were significantly lower than those in control group at the same time(all P<0.05).The times of analgesic pump pressing and the dosage of oxycodone in observation group were significantly less than those in control group(all P<0.05),and the time of anal exhaust and ambulation were significantly earlier than those in control group(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Low background dose oxycodone PCIA has a good effect and safety on analgesia after radical gastrectomy in elderly patients.Combined with RSB,it can further improve the analgesic effect and reduce the impact of surgery on the immune function and stress response of patients.