腰方肌阻滞联合全身麻醉对老年下腹部手术患者术后疼痛及炎症应激的影响

Effects of Quadratus Lumborum Block Combined with General Anesthesia on Postoperative Pain and Inflammatory Stress in Elderly Patients Undergoing Lower Abdominal Surgery

目的探究腰方肌阻滞联合全身麻醉对老年下腹部手术患者术后疼痛及炎症应激的影响。方法选取2022年2月至2023年4月山东省立第三医院收治的90例行下腹部手术的老年患者为研究对象。根据麻醉方式不同分为观察组和对照组,各45例,其中对照组采用全身麻醉,观察组采用腰方肌阻滞联合全身麻醉。全身麻醉采用咪达唑仑0.05 mg/kg、依托咪酯0.3 mg/kg、罗库溴铵1.0 mg/kg、枸橼酸舒芬太尼0.5μg/kg经静脉快速诱导,行气管插管,使用瑞芬太尼0.1μg/(kg·min)、七氟烷0.5~1最小肺泡浓度维持麻醉;腰方肌阻滞采用20 ml 0.25%罗哌卡因缓慢注射。记录两组的手术时间、术中出血量及苏醒时间,于术后苏醒24、48 h采用视觉模拟评分法(VAS)评分评价患者的疼痛程度,分别采集患者麻醉前、术后48 h的静脉血,比较两组患者的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平,以及两组不良反应发生情况。结果两组患者的手术时间、术中出血量比较差异无统计学意义(P>0.05),观察组苏醒时间短于对照组[(8.5±2.2)min比(10.1±2.2)min](P<0.01)。术后苏醒24、48 h VAS评分的主效应差异有统计学意义(P<0.01),不考虑测量时间,两组间VAS评分的主效应差异有统计学意义(P<0.01),组间和时点间不存在交互作用(P>0.05);术后苏醒48 h,两组VAS评分均低于术后苏醒24 h,且观察组低于对照组(P<0.05)。麻醉前后TNF-α、CRP、IL-6水平的主效应差异有统计学意义(P<0.01),不考虑测量时间,两组间TNF-α、CRP、IL-6的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.05或P<0.01);术后48 h,两组TNF-α、CRP、IL-6水平均较麻醉前升高,但观察组低于对照组(P<0.05)。观察组总不良反应发生率低于对照组[2.22%(1/45)比15.56%(8/45)](χ^(2)=4.444,P=0.035)。结论腰方肌阻滞联合全身麻醉可改善老年下腹部手术患者术后疼痛程度,减轻患者炎症应激反应。

Objective To explore the effects of quadratus lumborum block combined with general anesthesia on postoperative pain and inflammatory stress in elderly patients undergoing lower abdominal surgery.Methods 90 elderly patients undergoing lower abdominal surgery in Shandong Provincial Third Hospital from Feb.2022 to Apr.2023 were included as the study objects.According to different anesthesia methods,they were divided into an observation group and a control group,with 45 patients in each group.The control group was given general anesthesia,and the observation group was given quadratus lumborum block combined with general anesthesia.General anesthesia was induced by rapid intravenous induction of midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,rocuronium 1.0 mg/kg,sufentanil citrate 0.5μg/kg,and endotracheal intubation of remifentanil 0.1μg/(kg·min),sevoflurane 0.5-1 minimum alveolar concentration were used for anesthesia maintenance.The quadratus lumbois block was performed by slow injection of 20 ml 0.25%ropivacaine.The operative time,recovery time and intraoperative bleeding volume of the two groups were recorded.The visual analogue scale(VAS)score was used to evaluate the pain degree of the patients at 24 h and 48 h after recovery.Venous blood of the patients before anesthesia and 48 h after surgery were collected respectively,to compare the levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),as well as the occurrence of adverse reactions in the two groups.Results There was no significant difference in the operation time and intraoperative bleeding volume between the two groups(P>0.05),the awakening time of the observation group was shorter than that of the control group[(8.5±2.2)min vs(10.1±2.2)min](P<0.01).The difference in the main effect of VAS scores between postoperative 24 h and 48 h was statistically significant(P<0.01);regardless of measurement time,the main effect of VAS score between the two groups was statistically significantly different(P<0.01),while there was no interaction between groups and time points(P>0.05).At postoperative 48 h,the VAS score of both groups was lower than that at postoperative 24 h,and the observation group was lower than the control group(P<0.05).The main effects of TNF-α,CRP,and IL-6 levels before and after anesthesia were statistically significant(P<0.01),regardless of measurement time,the main effect differences of TNF-α,CRP,IL-6 between the two groups were statistically significant(P<0.01),and there were interactions between groups and time points(P<0.05 or P<0.01);at postoperative 48 h,TNF-α,CRP,IL-6 were increased from pre-anesthesia,but the observation group was lower than the control group(P<0.05).The total adverse reaction incidence in the observation group was lower than that in the control group[2.22%(1/45)vs 15.56%(8/45)](χ^(2)=4.444,P=0.035).Conclusion Quadratus lumborum block combined with general anesthesia can improve postoperative pain and reduce inflammatory stress in elderly patients undergoing lower abdominal surgery.