超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜手术中的镇痛效果及对患者应激反应、免疫功能的影响

Analgesic effect of ultrasound-guided transversus abdominis plane block combined with general anesthesia in laparoscopic surgery and its influences on stress response and immune function of patients

目的探讨超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜手术中的应用价值。方法选取2019年12月至2021年12月收治的100例腹腔镜手术患者,以随机数字表法将其分为对照组和观察组,各50例。对照组采用常规全身麻醉,观察组采用超声引导下腹横肌平面阻滞联合全身麻醉。比较两组的应用效果。结果术后1、6、12 h,观察组的视觉模拟评分法(VAS)评分低于对照组,舒适度评分法(BCS)评分高于对照组(P<0.05)。手术10 min、术毕、术后1 h,观察组的皮质醇(Cor)、肾上腺素(E)水平低于对照组(P<0.05)。术后24 h,观察组的自然杀伤(NK)细胞、白细胞分化抗原4阳性(CD4^(+))、白细胞分化抗原4阳性/白细胞分化抗原8阳性(CD4^(+)/CD8^(+))高于对照组(P<0.05)。结论超声引导下腹横肌平面阻滞联合全身麻醉有助于提高腹腔镜手术患者的镇痛效果,减轻应激反应,恢复免疫功能,值得推广。

Objective To explore the application value of ultrasound-guided transversus abdominis plane block combined with general anesthesia in laparoscopic surgery. Methods A total of 100 patients undergoing laparoscopic surgery admitted from December 2019 to December 2021 were selected and divided into control group and observation group by random number table method, with 50 cases in each group. The control group was given routine general anesthesia, and the observation group was given ultrasound-guided transversus abdominis plane block combined with general anesthesia. The application effects of the two groups were compared. Results At 1, 6 and 12 h after surgery, the Visual Analogue Scale (VAS) score of the observation group was lower than that of the control group, and the Bruggrmann Comfort Scale (BCS) score was higher than that of the control group (P<0.05). At 10 min after surgery, at the end of surgery and 1 h after surgery, the levels of cortisol (Cor) and epinephrine (E) in the observation group were lower than those in the control group (P<0.05). At 24 h after surgery, the natural killer (NK) cells, cluster of differentiation 4 positive (CD4^(+)) and cluster of differentiation 4 positive/cluster of differentiation 8 positive (CD4^(+)/CD8^(+)) in the observation group were higher than those in the control group (P<0.05). Conclusion Ultrasound-guided transversus abdominis plane block combined with general anesthesia is helpful to improve the analgesic effect of patients undergoing laparoscopic surgery, reduce stress response and restore immune function, which is worthy of promotion.