超声引导下竖脊肌平面阻滞复合全凭静脉麻醉在结直肠癌手术患者中的麻醉效果分析

Anesthetic Effect of Ultrasound-guided Erector Spinae Plane Block Combined with Total Intravenous Anesthesia in Patients Undergoing Colorectal Cancer Surgery

目的:分析结直肠癌患者术中采用超声引导下竖脊肌平面(ESP)阻滞复合全凭静脉麻醉(TIVA)的麻醉效果。方法:选取2020年1月-2021年12月在暨南大学附属第五医院行手术治疗的40~70岁结直肠癌患者100例作为研究对象,按随机数字表法分为对照组及观察组,各50例。对照组实施TIVA,观察组实施超声引导下ESP阻滞联合TIVA。比较两组围手术期情况(舒芬太尼用量、血流动力学不稳定次数、手术时间、苏醒时间),比较两组麻醉前、手术开始后30 min、拔管前、术后12 h时应激反应指标[去甲肾上腺素(NE)、皮质醇、肾上腺素(A)]水平,比较两组术前1 d、离开麻醉复苏室前5 min、术后24 h及术后48 h的免疫功能[自然杀伤细胞(NK)、辅助性T细胞1/辅助性T细胞2(Th1/Th2)],比较两组麻醉相关不良反应发生情况。结果:观察组舒芬太尼用量、血流动力学不稳定次数均少于对照组,苏醒时间早于对照组,差异均有统计学意义(P<0.05);手术开始后30 min、拔管前、术后12 h观察组的NE、皮质醇、A水平均低于对照组,差异均有统计学意义(P<0.05);术后离开麻醉复苏室前5 min、术后24 h及术后48 h观察组的NK、Th1/Th2水平均高于对照组,差异均有统计学意义(P<0.05)。结论:超声引导下ESP阻滞联合TIVA在结直肠癌手术患者中麻醉效果较好,可减少舒芬太尼用量,稳定血流动力学,缩短苏醒时间,且对患者应激反应及免疫功能影响较小。

Objective:To analyze the anesthetic effect of ultrasound-guided erector spinae plane(ESP)block combined with total intravenous anesthesia(TIVA)in patients with colorectal cancer surgery.Method:A total of 100 patients with colorectal cancer aged 40-70 who underwent surgical treatment in the Fifth Affiliated Hospital of Jinan University from January 2020 to December 2021 were selected as the research subjects.They were divided into control group and observation group by random number table method,with 50 cases in each group.The control group was treated with TIVA,and the observation group was treated with ESP block combined with TIVA under ultrasound guidance.The perioperative condition dosage of(Sufentanil,hemodynamic instability times,operation time and recovery time)of the two groups were compared.The levels of stress response indexes[norepinephrine(NE),cortisol and epinephrine(A)]at before anesthesia,30 minutes after operation,before extubation and 12 hours after operation were compared between the two groups.The immune functions[natural killer cells(NK),helper T cell 1/helper T cell 2(Th1/Th2)]at 1 day before operation,5 minutes before leaving the anesthesia and resuscitation room,24 hours after operation and 48 hours after operation were compared between the two groups.The occurrence of anesthesia related adverse reactions was compared between the two groups.Result:The dosage of Sufentanil and the times of hemodynamic instability in the observation group were less than those in the control group,and the recovery time was earlier than that in the control group,the differences were statistically significant(P<0.05).The levels of NE,cortisol and A in the observation group were lower than those in the control group at 30 minutes after operation,before extubation and 12 hours after operation,the differences were statistically significant(P<0.05).The levels of NK and Th1/Th2 in the observation group at 5 minutes before leaving the anesthesia and resuscitation room,24 hours and 48 hours after operation were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Ultrasound guided ESP block combined with TIVA has a good anesthetic effect in patients undergoing colorectal cancer surgery.It can reduce the dosage of Sufentanil,stabilize hemodynamics,shorten the recovery time,and has fewer effects on the stress response and immune function of patients.