腹横肌平面阻滞对腹腔镜结直肠癌根治术后患者疼痛、康复指标及免疫功能的影响

Effects of transversus abdominis plane block on pain,rehabilitation indexes and immune function in patients undergoing laparoscopic colorectal cancer surgery

目的探讨超声引导下腹横肌平面阻滞(TAPB)对腹腔镜结直肠癌根治术后患者疼痛、康复指标及免疫功能的影响。方法回顾性选取2019年2月至2021年2月上海市第一人民医院嘉定分院/上海市嘉定区江桥医院和上海市第一人民医院收治的100例行腹腔镜结直肠癌根治术患者作为研究对象,其中43例应用硬膜外阻滞(对照组),57例应用超声引导下TAPB(观察组)。比较两组临床指标、生命体征参数、术后疼痛程度和免疫功能情况。结果观察组排气时间、排便时间、下床时间及术后住院时间均短于对照组[(2.71±0.54)d比(2.99±0.66)d、(3.02±0.49)d比(3.49±0.56)d、(3.20±0.89)d比(3.85±1.08)d、(6.81±0.98)d比(7.71±1.08)d],差异有统计学意义(P<0.05)。两组麻醉前、切皮即刻、术毕舒张压、收缩压及心率比较差异无统计学意义(P>0.05)。观察组术后4、24、48、72 h视觉模拟量表(VAS)评分均低于对照组(P<0.05)。观察组术后3 d CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、IgM高于对照组[0.512±0.054比0.487±0.051、0.280±0.036比0.222±0.032、1.36±0.29比1.17±0.26、(152.53±34.3)kU/L比(138.86±31.18)kU/L],差异有统计学意义(P<0.05)。结论TAPB能有效减轻腹腔镜结直肠癌根治术患者术后疼痛程度及免疫抑制程度,从而促进患者术后康复。

Objective To observe the effects of ultrasound guided transversus abdominis plane block(TAPB)on pain,rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects,including 43 patients performed epidural block(control group)and 57 patients performed TAPB(observation group).The clinical indicators,vital signs parameters,pain degree,immune function in the two groups were compared.Results The exhausting time,defecation time,getting out of bed time and hospitalization time in observation group were shorter than those in control group:(2.71±0.54)d vs.(2.99±0.66)d,(3.02±0.49)d vs.(3.49±0.56)d,(3.20±0.89)d vs.(3.85±1.08)d,(6.81±0.98)d vs.(7.71±1.08)d,there were statistical differences(P<0.05).The diastolic blood pressure,systolic blood pressure and heart rate at pre-anesthesia,immediate incision of the skin,end of the surgery between two groups had no significant differences(P>0.05).The scores of visual analogue scale at 4,24,48 and 72 h after surgery in the observation group were significantly lower than those in the control group(P<0.05).The levels of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)and IgM after surgery for 3 d in the observation group were higher than those in the control group:0.512±0.054 vs.0.487±0.051,0.280±0.036 vs.0.222±0.032,1.36±0.29 vs.1.17±0.26,(152.53±34.3)kU/L vs.(138.86±31.18)kU/L,there were statistical differences(P<0.05).Conclusions TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery,so as to promote postoperative rehabilitation of patients.