超声引导下腹横肌平面阻滞联合静脉镇痛泵对腹腔镜胃癌根治术患者术后镇痛效果及认知功能的影响

Influences of ultrasound-guided transversus abdominis plane block combined with intravenous analgesia pump on postoperative analgesic effect and cognitive function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

目的研究超声引导下腹横肌平面阻滞联合静脉镇痛泵对腹腔镜胃癌根治术患者术后镇痛效果及认知功能的影响。方法选取2020年11月至2021年8月我院收治的54例腹腔镜胃癌根治术患者,采用随机数字表法将其分为对照组和观察组,每组27例。对照组术后采用静脉镇痛泵,观察组在此基础上联合超声引导下腹横肌平面阻滞。比较两组的手术及麻醉相关指标、镇静及疼痛评分、炎症因子水平、认知功能评分、不良反应发生情况。结果观察组的舒芬太尼用量少于对照组,术后首次使用镇痛药时间长于对照组(P<0.05)。术后6、12、48 h,观察组的Ramsay评分高于对照组,视觉模拟评分法(VAS)评分低于对照组(P<0.05)。术后12、48 h,观察组的肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平明显低于对照组(P<0.05)。术后3、7 d,观察组的简明精神状态检查表(MMSE)评分显著高于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论超声引导下腹横肌平面阻滞联合静脉镇痛泵应用于腹腔镜胃癌根治术患者术后,可延长术后首次使用镇痛药时间,避免大剂量追加舒芬太尼,减轻疼痛感及炎症反应,减少对患者认知功能的影响,且安全性高。

Objective To study the influences of ultrasound-guided transversus abdominis plane block combined with intravenous analgesia pump on postoperative analgesic effect and cognitive function in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods Fifty-four patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted in our hospital from November 2020 to August 2021 were selected and divided into control group and observation group by random number table method,with 27 cases in each group.The control group was given intravenous analgesia pump after operation,and the observation group was combined with ultrasound-guided transversus abdominis plane block on this basis.The operation and anesthesia related indexes,sedation and pain scores,inflammatory factors levels,cognitive function score and incidence of adverse reactions were compared between the two groups.Results The dosage of sufentanil in the observation group was less than that in the control group,and the time of first use of analgesics after operation was longer than that in the control group(P<0.05).At 6,12 and 48 h after operation,the Ramsay score of the observation group was higher than that of the control group,and the Visual Analogue Scale(VAS)score was lower than that of the control group(P<0.05).At 12 and 48 h after operation,the levels of tumor necrosis factor-α(TNF-α),high sensitivity C-reactive protein(hs-CRP)and interleukin-6(IL-6)in the observation group were significantly lower than those in the control group(P<0.05).At 3 and 7 d after operation,the Mini-Mental State Examination(MMSE)score of the observation group was significantly higher than that of the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The ultrasound-guided transversus abdominis plane block combined with intravenous analgesia pump applied in postoperative patients undergoing laparoscopic radical gastrectomy for gastric cancer can prolong the time of first use of analgesics after operation,avoid high-dose additional sufentanil,alleviate pain and inflammatory response,and reduce the impact on patients'cognitive function,with high safety.