超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

Application of ultrasound-guided quadratus lumborum block combined with propofol anesthesia in laparoscopic radical resection for colorectal cancer

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象,随机分为观察组和对照组,各45例。对照组采用传统腰麻联合丙泊酚麻醉,观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉,比较两组患者术中(麻醉后5、15、30、60 min)收缩压(SBP)、舒张压(DBP)、心率(HR)和术后不同时间段的疼痛评分(VAS评分),以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义(P<0.05),且观察组麻醉后上述指标波动较对照组小(P<0.05);麻醉前,两组患者皮质醇、肾上腺素水平无显著差异(P>0.05),麻醉后各时间点观察组患者上述指标水平均显著低于对照组(P<0.05);两组患者VAS评分组间、不同时间点及交互差异均有统计学意义(P<0.05),且观察组术后各时间点VAS评分均显著低于对照组(P<0.05);观察组不良反应发生率显著低于对照组(8.89%vs 24.44%,P<0.05);观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组(P<0.05)。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果,可有效缓解患者疼痛,减少术后不良反应发生。

Objective To explore the application value of ultrasound-guided quadratus lumborum block combined with propofol anesthesia in patients with colorectal cancer undergoing laparoscopic radical resection.Methods Ninety colorectal cancer patients scheduled for laparoscopic radical resection were enrolled as the study subjects,and they were randomly classified as observation group and control group,with 45 cases in each group.Control group was treated with traditional lumbar anesthesia combined with propofol anesthesia,while observation group was given ultrasound-guided quadratus lumborum block combined with propofol anesthesia.The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)during surgery(at 5,15,30 and 60 min after anesthesia)were recorded.Moreover,pain score(VAS score)at different time points after surgery as well as addition of analgesics and postoperative intestinal exhaust time and the incidence rate of adverse reactions within 48 h after surgery were compared between two groups.Results There were statistical differences in the between-group,time-point and interaction effects of SBP,DBP and HR between two groups(P<0.05),and the fluctuations of the above indicators after anesthesia were smaller in observation group compared with control group(P<0.05).Before anesthesia,the differences in the levels of cortisol and epinephrine between two groups were trivial(P>0.05),but the levels of above-mentioned indicators were significantly lower in observation group than in control group at each time point after anesthesia(P<0.05).The differences between two groups in between-group,time-point and interaction effects of VAS were also statistically significant(P<0.05),and the VAS scores of observation group at different time points after surgery were obviously lower than those of control group(P<0.05).The incidence rate of adverse reactions in observation group was 8.89%,markedly lower than 24.44%in control group(P<0.05).In observation group,the number of patients receiving additional analgesics and postoperative intestinal exhaust time were significantly less or shorter than those in control group(P<0.05).Conclusion Ultrasound-guided quadratus lumborum block combined with propofol anesthesia has a good and stable anesthetic effect in laparoscopic radical resection for colorectal cancer,and it can effectively relieve the pain and reduce the occurrence of postoperative adverse reactions.