多模式镇痛对结肠癌根治术患者围术期血流动力学、T淋巴细胞亚群及炎性因子的影响

Effects of multimodal analgesia on perioperative hemodynamics,T lymphocyte subsets and inflammatory factors in patients undergoing radical resection of colon cancer

目的:探讨结肠癌根治术麻醉诱导前行双侧腹横肌平面(TAP)阻滞与帕瑞昔布钠联用的多模式镇痛对患者围术期血流动力学、T淋巴细胞亚群及炎性因子的影响。方法:按照干预方式的不同,将84例结肠癌根治术患者分为观察组与对照组,每组各42例。对照组予以帕瑞昔布钠镇痛,观察组在对照组的基础上联用麻醉诱导前TAP阻滞的多模式镇痛。收集两组患者术后1、12、24、48 h血流动力学水平[平均动脉压(MAP)与心率(HR)]、T淋巴细胞亚群、炎性因子水平[血清γ-干扰素(INF-γ)与白细胞介素-6(IL-6)]及VAS疼痛评分的变化。结果:术后12、24、48 h,观察组MAP以及HR水平均少于对照组(P<0.05);CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均高于对照组(P<0.05)。术后1、12、24、48 h,观察组INF-γ水平均高于对照组(P<0.05),IL-6水平、VAS疼痛评分均低于对照组(P<0.05)。结论:结肠癌根治术患者实施麻醉诱导前行双侧TAP阻滞与帕瑞昔布钠联用的多模式镇痛疗效显著,可稳定其围术期血流动力学水平,改善术后患者体内的炎性因子状态,降低手术疼痛程度。

Objective:To analyze the effects of multimodal analgesia of bilateral transverse abdominal muscle plane(TAP)block combined with parecoxib sodium before anesthesia induction on perioperative hemodynamics,T lymphocyte subsets and inflammatory factors in patients with colon cancer.Methods:A total of 84 cases of colon cancer patients undergoing radical operation were divided into observation group and reference group according to different intervention methods,42 cases in each group.The reference group was given parecoxib sodium analgesia,and the observation group was combined with multimodal analgesia of tap block before anesthesia induction on the basis of the reference group.The levels of hemodynamics[mean arterial pressure(MAP),heart rate(HR)],T lymphocyte subsets and inflammatory factors[serum interferon-γ(INF-γ),nterleukin-6(IL-6)],and VAS pain score at 1,12,24 and 48 h after operation were collected.Results:The levels of MAP and HR at 12,24 and 48 h in the observation group were lower than those in the reference group(P<0.05).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)at 12,24 and 48 h in the observation group were higher than those in the reference group(P<0.05).The levels of INF-γin the observation group was higher than that in the reference group(P<0.05),the level of IL-6 and VAS pain score in the observation group were lower than those in the reference group at 1,12,24 and 48 h after operation(P<0.05).Conclusion:The multimodal analgesic effect of bilateral tap block combined with parecoxib sodium before anesthesia induction in patients with radical colon cancer is significant,which can stabilize the perioperative hemodynamic level,improve the state of inflammatory factors and reduce the degree of surgical pain.