全身麻醉联合腹横肌平面阻滞在腹腔镜胆囊切除术患者中的应用及对术后并发症的影响

Application of general anesthesia combined with transverse abdominal muscle plane block in patients undergoing laparoscopic cholecystectomy and its impact on postoperative complications

目的 探讨全身麻醉联合腹横肌平面阻滞(TAPB)在腹腔镜胆囊切除术(LC)患者中的应用及对术后并发症的影响。方法 前瞻性选取2019年6月至2022年12月于安徽省淮北矿工总医院医院行LC患者80例作为研究对象,按照抽签法分为两组,实验组及对照组,各40例。对照组采取全身麻醉,实验组采取全身麻醉联合TAPB。比较两组麻醉前(T_(1))、切皮时(T_(2))、分离切除胆囊时(T_(3))、缝皮时(T_(4))心率、无创平均动脉压(MAP)的变化。记录两组的苏醒时间、自主呼吸恢复时间、住院时间、舒芬太尼用量、有效按压镇痛泵次数。比较两组术后不同时点疼痛视觉模拟评分法(VAS)评分,术前和术后2 d的炎症因子指标[白细胞介素(IL)-6、IL-2、肿瘤坏死因子-α(TNF-α)]水平及术后并发症发生情况。结果 实验组T_(2)、T_(3)时心率、无创MAP均明显高于对照组,T_(4)时心率、MAP低于对照组,差异均有统计学意义(P<0.05)。实验组苏醒时间、自主呼吸恢复时间、住院时间分别为(9.46±1.57)min、(3.59±1.27)min、(4.12±1.35)d,均短于对照组[(11.03±1.74)min、(4.68±1.63)min、(5.83±1.40)d],舒芬太尼用量、有效按压镇痛泵次数分别为(129.43±18.28)μg、(2.39±0.39)次,均少于对照组[(138.50±19.71)μg、(8.64±2.20)次],差异均有统计学意义(P<0.05)。实验组术后8、12、24、48 h的VAS评分分别为(2.68±0.22)、(2.87±0.26)、(2.36±0.34)分,均明显低于对照组[(3.24±0.48)、(3.57±1.03)、(2.99±0.47)分],差异均有统计学意义(P<0.05)。实验组术后2 d的IL-6、IL-2、TFN-α水平分别为(6.56±0.62) pg/L、(0.32±0.13) ng/L、(7.34±1.52) ng/L,均显著低于对照组[(8.96±1.48) pg/L、(0.45±0.16) ng/L、(8.34±2.15) ng/L],差异均有统计学意义(P<0.05)。实验组总并发症发生率为10.00%,明显低于对照组(27.50%),差异有统计学意义(P<0.05)。结论 全身麻醉联合TAPB在LC中具有较好的应用价值,能加快术后苏醒时间,维持患者血流动力学,减轻术后疼痛,降低手术引起炎性反应,降低术后并发症发生率。

Objective To evaluate of the value of general anesthesia combined with transverse abdominal plane block in patients undergoing laparoscopic cholecystectomy(LC).Methods Eighty patients who underwent LC at Huaibei Miner General Hospital in Anhui Province from June 2019 to December 2022 were prospectively selected as the study subjects.They were divided into the experimental group and the control group according to the lotcery method,with 40 patients in each group.The control group received general anesthesia,while the experimental group received general anesthesia combined with TAPB.The changes of heart rate,non-invasive mean arterial pressure(MAP) at pre-anesthesia(T_(1)),skin incision(T_(2)),gallbladder separation and resection(T_(3)),skin suture(T_(4)),between the two groups were compared,as well as the awakening time,spontaneous breathing recovery time,hospitalization time,sufentanil dosage,the effective number of compressions analgesic pump presses were recorded,the pain visual analogue scale(VAS) scores at different time points after surgery,and the levels of inflammatory factor indicator[serum interleukin(IL)-6,IL-2,tumor necrosis factor-α(TNF-α) before surgery and 2 days after surgery,and incidence of postoperative complications were compared.Results At T_(2) and T_(3),the heart rate and non-invasive MAP of the experimental group were significantly higher than those of the control group,while at T_(4),the heart rate and MAP were lower than those of the control group,and the differences were statistically significant(P<0.05).The awakening time,spontaneous breathing recovery time,and hospitalization time of the experimental group were(9.46±1.57) minutes,(3.59±1.27) minutes,and(4.12±1.35) days,respectively,which were shorter than those of the control group [(11.03±1.74) minutes,(4.68±1.63) minutes,and(5.83±1.40) days],the dosage of sufentanil and the effective number of compressions of the analgesic pump were(129.43±18.28) μg,(2.39±0.39) times,respectively,which were less than those of the control group [(138.50±19.71)μg,(8.64±2.20) times],the differences were statistically significant(P<0.05).The VAS scores of the experimental group at 8,12,24,and 48 hours after surgery were(2.68±0.22),(2.87±0.26),and(2.36±0.34) points,respectively,which were significantly lower than those of the control group [(3.24±0.48),(3.57±1.03),and(2.99±0.47) points],and the differences were statistically significant(P<0.05).The levels of IL-6,IL-2,and TNF-α in the experimental group at 2 days after surgery were(6.56±0.62) pg/L,(0.32±0.13) ng/L,and(7.34±1.52) ng/L,respectively,which were significantly lower than those in the control group [(8.96±1.48) pg/L,(0.45±0.16) ng/L,and(8.34±2.15) ng/L],and the differences were statistically significant(P<0.05).The total incidence of complications in the experimental group was 10.00%,which was significantly lower than that in the control group(27.50%),the difference was statistically significant(P<0.05).Conclusion General anesthesia combined with TAPB has good application value in LC,which can accelerate postoperative recovery time,maintain patient hemodynamics,reduce postoperative pain,reduce inflammatory reactions caused by surgery,and reduce the incidence of postoperative complications.