超声引导下腰方肌神经阻滞对腹腔镜结直肠癌根治术患者术后镇痛效果及炎性因子的影响

Effects of ultrasound-guided quadratus lumborum block on analgesia and inflammatory factors after laparoscopic radical resection of colorectal cancer

目的研究超声引导下腰方肌神经阻滞(QLB)对腹腔镜结直肠癌根治术患者术后镇痛效果及炎性因子的影响。方法90例接受腹腔镜结直肠癌根治术患者,按照信封随机法分成常规组和研究组,各45例。研究组患者于手术结束后、拔管前在超声行引导下行双侧QLB,常规组患者给予等量的0.9%氯化钠溶液。比较两组术后不同时间点视觉模拟评分法(VAS)评分,不同时间点炎性因子[白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)]水平,术后恢复情况。结果两组患者术后12、24、48 h的VAS评分均明显高于术后6 h,但研究组患者术后6、12、24、48 h的VAS评分分别为(1.22±0.31)、(1.57±0.41)、(2.01±0.47)、(1.72±0.43)分,均低于常规组的(1.46±0.41)、(1.84±0.60)、(2.34±0.62)、(1.94±0.51)分,差异具有统计学意义(P<0.05)。两组手术结束时的IL-6、IL-1β及TNF-α水平比较差异均无统计学意义(P>0.05);研究组术后1 h、48 h和4 d的IL-6、IL-1β及TNF-α水平与本组手术结束时比较差异均无统计学意义(P>0.05);常规组术后1 h、48 h和4 d的IL-6、IL-1β及TNF-α水平均高于本组手术结束时,且研究组术后1 h、48 h和4 d的IL-6、IL-1β及TNF-α水平均低于常规组,差异具有统计学意义(P<0.05)。研究组患者的术后首次排气时间、术后首次下地时间以及住院时间分别为(16.77±2.54)h、(25.14±5.01)h、(6.14±1.37)d,均短于常规组的(19.61±3.09)h、(28.62±5.72)h、(7.32±1.84)d,差异具有统计学意义(P<0.05)。结论腹腔镜结直肠癌患者应用超声引导下QLB,可明显减轻术后疼痛感和炎症反应,加快患者的康复进程,值得在临床广泛应用。

Objective To study the effects of ultrasound-guided quadratus lumborum block(QLB)on analgesia and inflammatory factors after laparoscopic radical resection of colorectal cancer.Methods A total of 90 patients who underwent laparoscopic radical resection of colorectal cancer were divided into the conventional group and the research group according to the random envelope method,with 45 cases in each group.Patients in the research group underwent ultrasound-guided bilateral QLB at the end of surgery and before extubation,and patients in the conventional group were given equal amounts of 0.9%sodium chloride solution.Both groups were compared in terms of visual analogue scale(VAS)scores,levels of inflammatory factors[interleukin-6(IL-6),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)]at different time points after surgery,and postoperative recovery.Results The VAS scores in both groups at 12,24,and 48 h postoperatively were significantly higher than those at 6 h postoperatively;however,the VAS scores at 6,12,24,and 48 h postoperatively were(1.22±0.31),(1.57±0.41),(2.01±0.47),and(1.72±0.43)points in the research group,which were lower than those of(1.46±0.41),(1.84±0.60),(2.34±0.62),and(1.94±0.51)points in the conventional group;the differences were statistically significant(P<0.05).The differences in IL-6,IL-1βand TNF-αlevels at the end of surgery between the two groups were not statistically significant(P>0.05).There was no statistically significant differences in the levels of IL-6,IL-1βand TNF-αat 1 h,48 h and 4 d postoperatively in the research group compared with the end of surgery in this group(P>0.05).The levels of IL-6,IL-1βand TNF-αat 1 h,48 h and 4 d postoperatively in the conventional group were higher than those at the end of surgery in this group;the levels of IL-6,IL-1βand TNF-αat 1 h,48 h and 4 d postoperatively in the research group were lower than those in the conventional group;the differences were statistically significant(P<0.05).The time to first postoperative exhaust time,time to first postoperative ambulation,and hospitalization time were(16.77±2.54)h,(25.14±5.01)h,and(6.14±1.37)d in the research group,which were shorter than those of(19.61±3.09)h,(28.62±5.72)h,and(7.32±1.84)d in the conventional group,and the differences were statistically significant(P<0.05).Conclusion The application of ultrasound-guided QLB to laparoscopic colorectal cancer patients can significantly reduce postoperative pain and inflammatory response,and accelerate the recovery process of patients,which is worthy of extensive clinical application.