全身麻醉复合罗哌卡因腹横肌神经阻滞在结直肠癌根治术中的应用及对患者应激功能的影响

Effects of general anesthesia combined with ropivacaine hydrochloride transabdominal nerve block in radical resection of colorectal cancer and its influence on stress function of patients

目的研究全身麻醉复合罗哌卡因腹横肌神经阻滞在结直肠癌根治术中的应用效果及对患者应激功能指标的影响。方法将2018年1月至2020年1月接受结直肠癌根治术治疗的患者85例纳入研究。将其根据随机数字表法分作观察组42例和对照组43例。对照组予以全麻处理,观察组复合罗哌卡因腹横肌神经阻滞。分析2组术后不同时间点的疼痛、舒适度,手术前后应激功能指标以及炎性因子水平,不良反应发生情况等方面的差异。结果观察组术后4 h、8 h、12 h、24 h时VAS评分均低于对照组,而上述各时间点的BSC评分均高于对照组,差异有统计学意义(均P<0.05)。术后2 h、24 h时观察组皮质醇以及肾上腺素水平均低于对照组,差异有统计学意义(均P<0.05)。观察组及对照组在恶心呕吐、呼吸抑制、尿潴留以及术后谵妄发生率方面比较,差异无统计学意义(均P>0.05)。术后2 h、24 h时观察组血清IL-6、TNF-α水平均明显低于对照组,差异有统计学意义(均P<0.05)。结论全麻复合罗哌卡因腹横肌神经阻滞在结直肠癌根治术中的镇痛效果显著,有利于减轻患者的应激反应以及炎性反应,安全性较好,值得临床推广应用。

Objective To investigate the application effects of general anesthesia combined with ropivacaine hydrochloride transabdominal nerve block in radical resection of colorectal cancer and its effects on stress function indexes.Methods A total of 85 patients who underwent radical resection of colorectal cancer in our hospital from January 2018 to January 2020 were enrolled in the study,who were randomly divided into control group(n=43)and observation group(n=42).The patients in control group were treated by general anesthesia,however,the patients in observation group received general anesthesia combined with ropivacaine hydrochloride transabdominal nerve block.The pain degree and comfort degree in different time points after operation,and stress function indexes,inflammatory factor levels,adverse reactions were observed and compared between the two groups.Results The VAS scores at 4h,8h,12h and 24h after operation in observation group were significantly lower than those in control group,while the BSC scores were significantly higher than those in control group(P<0.05).The levels of cortisol and epinephrine at 2h and 24h after operation in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in the incidence rates of nausea and vomiting,respiratory depression,urinary retention and postoperative delirium between the two groups(P>0.05).Moreover the serum levels of IL-6 and TNF-αat 2h,24h after operation in observation group were significantly lower than those in control group(P<0.05).Conclusion The general anesthesia combined with ropivacaine hydrochloride transabdominal nerve block in the radical resection of colorectal cancer has significant analgesic effects,which is beneficial to reduce the patient’s stress response and inflammatory response,with better safety,therefor,it is worthy of clinical application and promotion.