腰方肌阻滞对腹腔镜肝癌根治术后炎症因子、疼痛递质的影响以及脑保护作用

Effects of Quadratus Lumborum Block on Inflammatory Factors, Pain Mediators andBrain Protection After Laparoscopic Hepatocellular Carcinoma Radical Surgery

目的探讨分析腰方肌阻滞对腹腔镜肝癌根治术后炎症因子、疼痛递质的影响以及脑保护的作用。方法选取2021年6月至2022年6月驻马店市中心医院收治的106例预行腹腔镜肝癌根治术患者,随机分为观察组和对照组,各53例。对照组患者接受全身麻醉下手术治疗,观察组患者接受腰方肌阻滞联合全身麻醉下手术治疗。分别于手术前和术后24 h时,取患者血清样本,采用酶联免疫吸附法测定炎症因子、疼痛递质水平,采集桡动脉血及颈内静脉球部血测定脑氧代谢指标水平,并于手术前后采用简易精神状态检查表(MMSE)评估患者认知功能。结果术前,两组患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)等炎症因子和P物质(SP)、神经肽Y(NPY)、多巴胺(DA)、去甲肾上腺素(NE)等疼痛递质及颈内静脉球部血氧饱和度(SjvO_(2))、桡动脉颈内静脉球部血氧含量差(Da-jvO_(2))、脑氧摄取率(CEO_(2))等脑氧代谢指标水平差异无统计学意义(P>0.05);术后,两组患者血清IL-6、IL-10、TNF-α、SP、NPY、DA、NE、Da-jvO_(2)、CEO_(2)较术前升高,观察组低于对照组(P<0.05);而SjvO_(2)较术前降低,但观察组高于对照组(P<0.05)。术前,两组患者MMSE评分差异无统计学意义(P>0.05);术后,两组患者MMSE评分降低,而术后观察组高于对照组(P<0.05)。结论腹腔镜肝癌根治术采取腰方肌阻滞可有效减轻术后炎症因子、疼痛递质水平,改善脑氧代谢,进而促进术后认知功能恢复,对脑保护具有积极作用。

Objective To explore and analyze the effects of quadratus lumborum block on inflammatory factors,pain mediators and brain protection after laparoscopic hepatocellular carcinoma radical surgery.Methods A total of 106 patients treated in Zhumadian Central Hospital from June 2021 to June 2022 who underwent laparoscopic radical hepatoma were selected and randomly divided into observation group and control group,with 53 cases in each group.The control group received surgical treatment under general anesthesia,and the observation group received surgical treatment under quadratus lumborum block combined with general anesthesia.Serum samples were collected before surgery and 24 h after surgery,and the levels of inflammatory factors and pain mediators were determined by enzyme-related immunosorbent assay.Radial artery blood and internal jugular vein bulbar blood were collected to measure the cerebral oxygen metabolism index.The cognitive function of patients was assessed by the mini-mental state examination(MMSE)before and after surgery.Results Before surgery,there were no differences in serum inflammatory factors such as interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),pain mediators such as substance(SP),neuropeptide(NPY),dopamine(DA),norepinephrine(NE)and brain oxygen metabolism indexes such as jugular bulb venous oxygen saturation(SjvO_(2)),arterial-internal jugular vein bulb blood oxygen content difference(Da-jvO_(2)),cerebral oxygen extraction rate(CEO_(2))between two groups(P>0.05).After surgery,serum levels of IL-6,IL-10,TNF-α,SP,NPY,Da,NE,Da-jvO_(2) and CEO_(2) in two groups were higher than those before surgery,and the observation group were lower than those in control group(P<0.05).SjvO_(2) was lower than that before surgery,but the observation group was higher than the control group(P<0.05).Before surgery,there was no difference in MMSE scores between two groups(P>0.05).Before surgery,there was no difference MMSE score between the two groups(P>0.05).After surgery,MMSE score was decreased in both groups,while the postoperative observation group was higher than the control group(P<0.05).Conclusion Laparoscopic radical resection of liver cancer by means of quadratus lumborum block can effectively reduce postoperative inflammatory factors and pain mediators,improve cerebral oxygen metabolism,and promote postoperative cognitive function recovery,which has a positive effect on brain protection.