超声引导下腰方肌阻滞联合丙泊酚麻醉在结直肠癌根治术中的应用效果分析

Application effect of ultrasound-guided quadratus lumbosum block combined with propofol anesthesia in radical resection of colorectal cancer

目的研究超声引导下腰方肌阻滞(QLB)联合丙泊酚麻醉在结直肠癌根治术中的应用效果。方法纳入我院行经腹结直肠癌根治术的患者106例,按照随机数字表法将患者分为对照组及观察组,每组53例。观察组行超声引导下QLB联合丙泊酚麻醉,对照组行七氟醚联合舒芬太尼麻醉。比较2组患者手术及苏醒相关指标(手术时间、麻醉持续时间、苏醒时间、气管拔管时间、首次下床时间、首次排气时间)、围术期镇痛药物使用情况、不同时间点血流动力学指标变化、手术前后血清血管内皮生长因子-C(VEGF-C)及转化生长因子-β1(TGF-β1)水平。结果2组患者的手术时间及麻醉持续时间比较,差异无统计学意义(P>0.05);观察组患者苏醒时间、气管拔管时间、首次下床时间及首次排气时间均明显短于对照组,差异有统计学意义(P<0.05)。观察组患者在术中、术后24 h及术后48 h的舒芬太尼使用量均少于对照组(P<0.05);对照组患者术后首次使用患者自控静脉镇痛(PCIA)的时间明显早于观察组(P<0.05)。重复测量方差结果显示,观察组与对照组术中心率(HR)及平均动脉压(MAP)比较差异无统计学意义(P>0.05)。在不同时间点的比较中,观察组患者在T4、T6时的HR与MAP均明显低于对照组,差异均有统计学意义(P<0.05),而在T1、T2、T3、T5、T7时,组间比较差异无统计学意义(P>0.05)。2组患者术前血清VEGF-C及TGF-β1水平比较差异无统计学意义(P>0.05);对照组患者术后血清VEGF-C及TGF-β1水平较术前明显升高(P<0.05),而观察组患者术后血清VEGF-C及TGF-β1水平较术前无明显差异(P>0.05)。观察组患者术后血清VEGF-C及TGF-β1水平均明显低于对照组,差异有统计学意义(P<0.05)。结论超声引导下QLB联合丙泊酚麻醉在结直肠癌根治术中安全有效,可保持术中血流动力学稳定,并可降低患者术后早期血清VEGF-C及TGF-β1水平,促进患者术后恢复。

Objective To study the effect of ultrasound-guided quadratus lumbosum block(QLB)combined with propofol anesthesia in radical resection of colorectal cancer.Methods A total of 106 patients who underwent transabdominal radical resection of colorectal cancer in our hospital were included.According to the random number table method,the patients were divided into the control group and the observation group,with 53 cases in each group.The observation group underwent ultrasound-guided QLB combined with propofol anesthesia,and the control group underwent sevoflurane combined with sufentanil anesthesia.The surgery and awakening related indexes(operation time,anesthesia duration,awaking time,tracheal extubation time,first time out of bed,first exhaust time),the use of analgesic drugs in perioperative period,the changes of hemodynamic indexes at different time points,and the levels of serum vascular endothelial growth factor-C(VEGF-C)and transforming growth factor-β1(TGF-β1)before and after operation were compared between the two groups.Results There was no statistically significant difference in the operation time or anesthesia duration between the two groups(P>0.05).The awaking time,tracheal extubation time,first time out of bed and first exhaust time in the observation group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).The usage of sufentanil in the observation group was less than that in the control group during the operation,24 hours and 48 hours after operation(P<0.05).The time of the first use of patient-controlled intravenous analgesia(PCIA)after operation in the control group was significantly earlier than that in the observation group(P<0.05).Repeated measurement variance results showed that there was no statistically significant difference in the intraoperative heart rate(HR)or mean arterial pressure(MAP)between the observation group and the control group(P>0.05).Among the comparisons at different time points,the HR and MAP in the observation group at T4 and T6 were significantly lower than those in the control group,and the differences were statistically significant(P<0.05),while the differences between the two groups were not statistically significant at T1,T2,T3,T5 or T7(P>0.05).There was no statistically significant difference in the levels of serum VEGF-C or TGF-β1 between the two groups before operation(P>0.05).The levels of serum VEGF-C and TGF-β1 after operation in the control group were significantly higher than those before operation(P<0.05),while the levels of serum VEGF-C and TGF-β1 after operation in the observation group were not significantly different from those before operation(P>0.05).The levels of serum VEGF-C and TGF-β1 after operation in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided QLB combined with propofol anesthesia is safe and effective for radical resection of colorectal cancer,which can maintain the stability of intraoperative hemodynamics,reduce the levels of serum VEGF-C and TGF-β1 in the early postoperative period,and promote postoperative recovery of patients.