腹横筋膜平面阻滞复合全麻对腹腔镜下子宫内膜癌根治术后舒芬太尼镇痛效果

Influence of transversus abdominis plane block combined with general anesthesia during laparoscopic radical resection of endometrial cancer of patients on the sufentanil dosage and the analgesic effect

目的:探究腹横筋膜平面(TAP)阻滞复合全麻对腹腔镜下子宫内膜癌(EC)根治术后舒芬太尼用量及镇痛效果。方法:选择2020年1月-2021年9月本院行手术治疗的EC患者126例,按照随机数表法分成观察组(n=63)和对照组(n=63)。两组术中均全麻、术后均采用静脉自控镇痛(PCIA),观察组采用TAP阻滞。比较两组术后4、8、12、24h时的疼痛评分(VAS),苏醒时间、首次自主呼吸恢复时间、舒芬太尼用量、PCIA每24h有效按压次数、术后不良反应发生情况;比较术前及术后12h应激反应指标[皮质醇(Cor)、血糖(Glu)]及白细胞介素-6(IL-6)水平。结果:观察组术后4、8、12、24h时VAS评分分别为(3.64±0.57分、3.05±0.63分、2.53±0.58分、1.77±0.49分)均低于对照组(4.73±0.62分、3.84±0.71分、3.11±0.64分、2.42±0.51分);苏醒时间(6.1±1.5min)、自主呼吸恢复时间(7.3±2.1min)、PCIA每24h有效按压(2.5±0.6次)、术后舒芬太尼用量(61.4±1.1μg)、Glu(5.91±1.02mmol/L)、Cor(273.54±30.28μg/L)、IL-6(170.57±20.68pg/ml)水平及不良反应总发生率(4.8%)均低于对照组(7.2±2.0min、10.7±3.2min、3.6±1.0次、64.8±3.5μg、7.35±0.97mmol/L、365.27±32.51μg/L、315.14±25.26pg/ml、15.9%)(均P<0.05)。结论:TAP阻滞复合全麻对EC患者术后镇痛质量高,可减少术后舒芬太尼用量,降低患者应激及炎症反应,改善苏醒质量,且具有一定安全性。

Objective: To explore the influence of transversus abdominis plane(TAP) block combined with general anesthesia during laparoscopic radical resection of endometrial cancer(EC) of patients on the sufentanil dosage and the analgesic effect. Methods: A total of 126 patients who wanted laparoscopic radical resection of EC were enrolled and were divided into two groups(63 cases in each group) according to random number table method from January 2020 to September 2021. The patients in both groups were treated with general anesthesia during operation and the patient controlled intravenous analgesia(PCIA) were given the patients in both groups after operation. TAP block was used for the patients in the observation group. The scores of visual analogue scales(VAS) at 4h, 8h, 12h, and 24h after operation, the awakening time, the first exhaust time, the sufentanil dosage, the times of effective PCIA compression per 24h, the postoperative adverse reactions, the levels of stress response indexes at 12h after operation, such as cortisol(Cor) and blood glucose(Glu), and the interleukin-6(IL-6) level of the patients were compared between the two groups. Results: The VAS scores of the patients in the observation group at postoperative 4, 8, 12 and 24h were 3.64±0.57 points, 3.05±0.63 points, 2.53±0.58 points, and 1.77±0.49 points, respectively, which were significantly lower than those(4.73±0.62 points, 3.84±0.71 points, 3.11±0.64 points, and 2.42±0.51 points) of the patients in the control group. The awakening time(6.1±1.5min), the recovery time of spontaneous respiration(7.3±2.1min),the times of effective compression of PCIA per 24h(2.5±0.6times),the postoperative dosage of sufentanil(61.4±1.1μg),the levels of Glu(5.91±1.02mmol/L),Cor(273.54±30.28μg/L),and IL-6(170.57±20.68pg/ml),and the total incidence of adverse reactions(4.8%)of the patients in the observation group were significantly lower than those(7.2±2.0min,10.7±3.2min,3.6±1.0times,64.8±3.5μg,7.35±0.97mmol/L,365.27±32.51μg/L,315.14±25.26pg/ml,and 15.9%)of the patients in the control group(all P<0.05).Conclusion:TAP block combined general anesthesia is of high postoperative analgesia quality for the patients with EC,which can reduce the postoperative sufentanil dosage,alleviate stress and inflammatory response of the patients,and improve the awakening quality,with certain safety.