全身麻醉复合区域神经阻滞对超低位直肠癌患者术中血压、心率及术后VAS评分的影响

Effect of general anesthesia combined with regional nerve block on intraoperative blood pressure,heart rate and postoperative VAS score in patients with ultra-low rectal cancer

目的探讨全身麻醉复合区域神经阻滞对超低位直肠癌患者术中血压、心率(heart rate,HR)及术后视觉模拟评分法(visual analogue scale,VAS)评分的影响。方法选取2020年1月至2022年4月高安市人民医院收治的超低位直肠癌患者75例,根据随机数字表法将其分为A组、B组和C组,每组各25例;A组患者给予单纯静脉麻醉,B组患者给予全身麻醉复合硬膜外阻滞麻醉,C组患者给予全身麻醉复合区域神经阻滞;比较三组患者的临床相关指标、平均动脉压(mean arterial pressure,MAP)、HR、血氧饱和度(oxygen saturation,SO_(2))、VAS评分、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-10(interleukin-10,IL-10)、皮质醇(cortisol,Cor)、去甲肾上腺素(noradrenaline,NE)。结果三组患者的排气时间、卧床时间、住院时间、自主呼吸恢复时间、苏醒时间、拔除气管导管时间比较差异均有统计学意义,且其时间均为A组>B组>C组(P<0.05)。切皮5min,三组患者的MAP、HR均显著高于本组术前,SO_(2)均显著低于本组术前(P<0.05);B组和C组患者的MAP、HR均显著低于A组,SO_(2)均显著高于A组(P<0.05)。术后24h,三组患者的VAS评分均显著低于本组拔管后30min(P<0.05);拔管后30min和术后24h,B组和C组患者的VAS评分均显著低于A组(P<0.05)。术后24h,三组患者的TNF-α、IL-10、Cor、NE水平均显著高于本组术前(P<0.05);B组和C组患者的TNF-α、IL-10、Cor、NE水平均显著低于A组(P<0.05)。结论超低位直肠癌患者应用全身麻醉复合区域神经阻滞与全身麻醉复合硬膜外阻滞均可有效缓解疼痛、减轻炎症和应激反应,稳定HR及血压水平,且全身麻醉复合区域神经阻滞更利于患者的术后恢复。

Objective To investigate the effect of general anesthesia combined with regional nerve block on intraoperative blood pressure,heart rate(HR)and postoperative visual analogue scale(VAS)score in patients with ultra-low rectal cancer.Methods From January 2020 to April 2022,75 patients with ultra-low rectal cancer admitted to Gao’an People’s Hospital were selected and divided into group A,group B and group C according to random number table method,with 25 cases in each group.Group A was given simple intravenous anesthesia,group B was given general anesthesia combined with epidural anesthesia,group C was given general anesthesia combined with regional nerve block anesthesia.Clinical correlation indexes,mean arterial pressure(MAP),HR,oxygen saturation(SO_(2)),VAS score,tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),cortisol(Cor),and noradrenaline(NE)were compared among the three groups.Results There were statistically significant differences in exhaust time,bed time,hospital stay,recovery time of spontaneous respiration,wake time and tracheal catheter removal time among the three groups,and the time was group A>group B>group C(P<0.05).After 5 minutes of peeling,MAP and HR of three groups were significantly higher than those before surgery,and SO_(2)was significantly lower than those before surgery(P<0.05),MAP and HR of group B and group C were significantly lower than those of group A,and SO_(2)was significantly higher than that of group A(P<0.05).24h after surgery,the VAS score of three groups was significantly lower than that of this group 30min after extubation(P<0.05),VAS scores in group B and group C were significantly lower than those in group A at 30min after extubation and 24h after surgery(P<0.05).24h after surgery,the levels of TNF-α,IL-10,Cor and NE in three groups were significantly higher than those before surgery(P<0.05),the levels of TNF-α,IL-10,Cor and NE in group B and group C were significantly lower than those in group A(P<0.05).Conclusion In patients with ultra-low rectal cancer,both general anesthesia combined with regional nerve block and general anesthesia combined with epidural block can effectively relieve pain,reduce inflammation and stress response,and stabilize HR and blood pressure levels,and general anesthesia combined with regional nerve block is more conducive to postoperative recovery of patients.