腹横肌阻滞对结肠癌患者应激反应和炎性介质及免疫功能的影响

Effects of transverse abdominis plane block on stress response, inflammatory mediator and function of the immune system in patients with colon cancer

目的 探讨腹横肌阻滞复合全麻对结肠癌患者术中应激反应及术后炎性介质和免疫功能的影响。方法 选取2019年1月至2021年6月间上海市青浦区朱家角人民医院和上海市复旦大学附属中山医院青浦分院收治的120例结肠癌患者,采用随机数表法分为观察组和对照组,每组60例。对照组给予常规全麻,观察组在此基础上复合腹横肌平面阻滞(TAPB)。观察比较两组术中应激反应[去甲肾上腺素(NE)、肾上腺素(E)及皮质醇(Cor)]水平变化及术前、术后6h、术后12h和术后24h的免疫功能、炎性介质[肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)]水平。结果 不同组别、时点、交互的CD4^(+)、CD4^(+)/CD8^(+)具有差异,且观察组术后6h、12h及24h高于对照组,差异均有统计学意义(均P<0.05)。不同组别、时点的CD8^(+)具有差异,观察组术后6h、12h及24h高于对照组,差异均有统计学意义(均P<0.05)。不同组别、时点、交互的TNF-α和IL-6水平具有差异,且观察组术后6h、12h及24h低于对照组,差异均有统计学意义(均P<0.05)。不同组别、时点、交互的VAS评分具有差异,观察组术后6h、12h及24h低于对照组,差异均有统计学意义(均P<0.05)。不同组别、交互的镇静评分具有差异,观察组术后6h和12h低于对照组,差异均有统计学意义(均P<0.05)。不同组别、时点、交互的NE、E和Cor水平具有差异,且观察组手术开始后10min、手术开始后30min及手术结束即刻低于对照组,差异均有统计学意义(均P<0.05)。结论 全麻基础上复合TAPB能缓解手术应激反应,降低炎症介质水平,保护机体免疫功能,促进术后免疫功能恢复及改善炎症反应,具有更好的镇静镇痛效果。

Objective To investigate the effects of transversus abdominis plane block(TAPB) combined with general anesthesia on stress response, postoperative inflammatory mediators and function of the immune system in patients with colon cancer. Methods A total of 120 colon cancer patients admitted to Zhujiajiao People’s Hospital, Shanghai Qingpu District and Qingpu Campus, Zhongshan Hospital Affiliated to Fudan University were selected from January 2019 to June 2021. They were randomly divided into an observation group and a control group with 60 patients each. The observation group received TAPB combined with general anesthesia and the control group was given conventional general anesthesia. Changes in the levels of intraoperative stress response including norepinephrine(NE), epinephrine(E), cortisol(Cor) and function of the immune system, inflammatory mediators including tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)]were observed and compared before the operation and at 6 h, 12 h and 24 h after the operation. Results There were statistically significant differences in CD4^(+), CD4^(+)/CD8^(+)and CD8^(+)among different groups at different time points, and these levels were higher in the observation group than in the control group at 6 h, 12 h and 24 h after the operation(all P<0.05). There were statistically significant differences in levels of TNF-α, IL-6 and visual analogue scale(VAS) among different groups at time points, and these levels were significantly lower in the observation group than in the control group at 6 h, 12 h, and 24 h after surgery(all P<0.05). Moreover, differences in sedation score were significant among different groups at different time points it was significantly lower in the observation group than in the control group at 6 h and 12 h after surgery(all P<0.05). Differences in NE, E, Cor levels were significant among different groups at different time points, and NE, E, Cor levels were statistically lower in the observation group than in the control group for the first 10 min and 30 min of the operation and immediately after the operation(all P<0.05). Conclusion Transverse abdominis plane block added to general anesthesia can relieve surgical stress response, reduce the level of inflammatory mediators, protect the function of the immune system, promote the recovery of postoperative immune function and improve inflammatory response with good sedative and analgesic effects.