结直肠癌根治术中右美托咪定结合超声引导的腹横筋膜全麻阻滞临床观察

Application of dexmedetomidine combined with ultrasound-guided transverse abdominal fascia block during radical colorectal cancer surgery under general anesthesia

背景结直肠癌根治术是结直肠癌主要治疗手段,围术期需给予有效的麻醉方案,保障手术顺利进行.右美托咪定是常用麻醉药物,但其在全麻结直肠癌根治术中的最佳剂量尚不明确.目的探讨不同剂量右美托咪定结合超声引导下腹横筋膜阻滞用于全麻结直肠癌根治术的应用效果.方法选取2017-10/2022-09我院200例拟行全麻结直肠癌根治术患者,随机数字表法分为3组.3组均采取超声引导下横筋膜阻滞,A组67例给予0.5μg/kg右美托咪定,B组67例给予0.25μg/kg右美托咪定,C组66例给予等剂量生理盐水.统计比较3组麻醉诱导前(T0)、右美托咪定注射后(T1)、手术开始1小时(T2)、手术结束即刻(T3)生命体征[心率(heart rate,HR)、血氧饱和度(oxygen saturation,SaO_(2))、平均动脉压(mean arterial pressure,MAP)],术后6 h、12 h、24 h视觉模拟量表(visual analogue scale,VAS)评分、术后24 h镇痛泵按压次数、补救性镇痛次数,术前、术后12 h、24 h免疫细胞因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-2(interleukin-2,IL-2)、白介素-10(interleukin-10,IL-10)]、血清神经递质[血清S100B蛋白(serum S100B protein,S100B)、血清神经元特异性烯醇化酶(serum neuron-specific enolase,NSE)、血清脑源性神经营养因子(brain derived neurophic factor,BDNF)]水平及不良反应.结果(1)T0-T3时3组SaO_(2)比较差异无统计学意义,T1、T2时A组HR、MAP低于B组、C组,且B组小于C组(P<0.05);(2)A组术后6 h、12 h、24 h VAS评分低于B组、C组,术后24 h镇痛泵按压次数、补救性镇痛次数少于B组、C组,且B组优于C组(P<0.05);(3)术后12 h、24 h A组血清TNF-α、IL-10低于B组、C组,IL-2高于B组、C组,且B组优于C组(P<0.05);(4)术后12 h A组血清S100B、NSE低于B组、C组,BDNF高于B组、C组,且B组优于C组(P<0.05);(5)3组不良反应发生率比较差异无统计学意义.结论相比0.25μg/kg右美托咪定,0.5μg/kg右美托咪定结合超声引导下腹横筋膜阻滞用于全麻结直肠癌根治术中可更有效维持患者生命体征稳定,对患者免疫功能、神经功能影响较小,术后镇痛效果更好,且不会增加不良反应发生风险.

BACKGROUND Radical surgery is the main treatment for colorectal cancer,and effective anaesthesia is required in the perioperative period to ensure a smooth operation.Dexmedetomidine is a commonly used anaesthetic drug,but the optimal dose for general anaesthesia in radical colorectal cancer surgery is still unknown.AIM To investigate the application of different doses of dexmede-tomidine combined with ultrasound-guided transverse abdominal fascial block in radical colorectal cancer surgery under general anesthesia.METHODS Two hundred patients proposed for radical colorectal cancer surgery under general anesthesia at our hospital from October 2017 to September 2022 were selected and divided into three groups(A,B,and C)using the random number table method.Sixty-seven patients in group A were given 0.5μg/kg dexmedetomidine,67 patients in group B were given 0.25μg/kg dexmedetomidine,and 66 patients in group C were given an equal dose of saline.The vital signs[heart rate(HR),oxygen saturation(SaO_(2)),and mean arterial pressure(MAP)]before induction of anesthesia(T0),after dexmedetomidine injection(T1),1 h after the start of surgery(T2),and immediately after the end of surgery(T3),the visual analog scale(VAS)scores at 6 h,12 h,and 24 h after surgery,the number of analgesic pump compressions at 24 h after surgery,the number of times of remedial analgesia,the levels of immune cytokines[tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),and interleukin-10(IL-10)],serum neurotransmitter[serum S100B protein(S100B),serum neuron-specific enolase(NSE),and serum brain-derived neurotrophic factor(BDNF)]before surgery and 12 h and 24 h after surgery,and adverse effects were recorded.RESULTS There was no statistically significant difference in SaO_(2)among the three groups from T0 to T3(P>0.05),and HR and MAP at T1 and T2 were lower in group A than in groups B and C,and in group B than in group C(P<0.05).VAS scores in group A were lower than those in groups B and C at 6 h,12 h,and 24 h postoperatively,and the number of analgesic pump compressions and times of remedial analgesia at 24 h postoperatively were less in group A than in groups B and C(P<0.05),and in group B than in group C(P<0.05).Serum TNF-αand IL-10 at 12 h and 24 h postoperatively were lower in group A than in groups B and C,and IL-2 was higher than in groups B and C;these indexes in group B were superior to those in group C(P<0.05).Serum S100B and NSE at 12 h postoperatively were lower in group A than in groups B and C,and BDNF was higher than in groups B and C;these indexes in group B were superior to those in group C(P<0.05).The differences in the incidence of adverse reactions were not statistically significant among the three groups(P>0.05).CONCLUSION Compared with 0.25μg/kg dexmedetomidine,0.5μg/kg dexmedetomidine combined with ultrasound-guided transverse abdominal fascial block for radical colorectal cancer surgery under general anesthesia can more effectively maintain the stability of patients’vital signs,with less impact on patients’immune function and neurological function,and better postoperative analgesia without increasing the risk of adverse effects.