双侧双重腹横肌平面阻滞对全麻下腹腔镜直肠癌根治术患者驱动压及术后肺部并发症的影响

EFFECTS OF BILATERAL DUAL TRANSVERSE ABDOMINIS PLANE BLOCK ON DRIVING PRESSURE AND POSTOPERATIVE PULMONARY COMPLICATIONS IN LAPAROSCOPIC RADICAL RESECTION OF RECTAL CANCER UNDER GENERAL ANESTHESIA

目的探讨超声引导双侧双重腹横肌平面(BD-TAP)阻滞对全麻下腹腔镜直肠癌根治术患者驱动压(DP)和术后肺部并发症(PPC)的影响。方法选择2021年1-12月于我院择期行腹腔镜直肠癌根治术的患者60例,根据麻醉方式不同随机分配到GA组(30例,全身麻醉)和BD-TAP组(30例,全身麻醉联合BD-TAP阻滞)。两组患者均接受肺保护性通气和间断肺复张操作。比较两组患者气管插管后5 min(t1)、建立气腹后5 min(t2)、头低脚高位后5 min(t3)、头低脚高位后60 min(t4)及气腹放气恢复水平位后5 min(t5)的DP,并观察术后7 d内PPC的发生情况。结果与GA组比较,BD-TAP组在t2、t3、t4时间点DP明显降低(F=28.21~29.25,P<0.05),t1、t5时间点两组DP比较差异无统计学意义(P>0.05)。与GA组比较,BD-TAP组术后7 d内PPC发生率明显降低(χ^(2)=8.08,P<0.05)。结论BD-TAP阻滞可降低全麻下腹腔镜直肠癌根治术气腹和头低脚高位期间的DP,降低PPC发生率。

Objective To investigate the effects of ultrasound-guided bilateral dual transverse abdominis plane(BD-TAP)block on driving pressure(DP)and postoperative pulmonary complications(PPC)in patients undergoing laparoscopic radical resection for rectal cancer under general anesthesia(GA).Methods We included a total of 60 patients undergoing elective laparoscopic radical resection for rectal cancer in our hospital from January to December 2021.Based on the types of anesthesia,they were randomly assigned into GA group(n=30,GA alone)or BD-TAP group(n=30,GA combined with BD-TAP block).Both groups received lung-protective ventilation and intermittent lung recruitment maneuvers.The two groups were compared in terms of DP at five time points[5 min after endotracheal intubation(t1),5 min after establishment of the pneumoperitoneum(t2),5 min(t3)and 60 min(t4)after Trendelenburg positioning,and 5 min after the release of the pneumoperitoneum and returning to the horizontal position(t5)]and the incidence of PPCs within 7 days after operation.Results The DP was significantly lower in the BD-TAP group than in the GA group at t2,t3,and t4(F=28.21-29.25,P<0.05),with no significant differences at t1 and t5(P>0.05).The BD-TAP group showed a significantly lower incidence of PPC within 7 days after operation compared with the GA group(χ^(2)=8.08,P<0.05).Conclusion BD-TAP block can reduce the DP during the pneumoperitoneum and Trendelenburg position in laparoscopic radical resection of rectal cancer under GA,and reduce the incidence of PPC.