超声引导下腰方肌阻滞对老年下腹部手术患者应激反应及炎症因子的影响

Effect of ultrasound-guided trapezius muscle block on stress response and inflammatory factor levels in elderly patients undergoing lower abdominal surgery

目的探讨超声引导下腰方肌阻滞对老年下腹部手术患者应激反应及炎症因子的影响。方法前瞻性收集2021年3月至2022年3月在浙江中医药大学附属金华中医院收治的行老年下腹部手术患者90例,按随机数字表法分为研究组和对照组,每组45例。两组患者均采用全凭静脉麻醉,研究组联合应用超声引导下腰方肌阻滞术(0.5%利多卡因30 m L+0.2%罗哌卡因20 m L+0.9%氯化钠溶液5 mL)后进行手术。比较两组患者手术前后应激反应指标[心率(HR)、舒张压(DBP)、收缩压(SBP)、心输出量(CO)]、炎症因子(IL-6、CRP、TNF-α)、静息和运动时视觉模拟评分法(VAS)、术后相关指标、术后3 d不良反应发生情况。结果研究组术后24、72 h的IL-6、CRP、TNF-α水平及HR、DBP、SBP、CO均低于对照组,差异均有统计学意义(均P<0.05)。研究组患者静息和运动时VAS评分均低于对照组,差异均有统计学意义(均P<0.05)。与对照组比较,研究组术后排气时间、术后初次走路时长变化水平均降低,差异均有统计学意义(均P<0.05)。研究组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论应用超声引导下腰方肌阻滞能够有效改善老年下腹部手术患者术后疼痛感,调节应激反应,降低炎症因子的水平,安全性较高。

Objective To investigate the effect of ultrasound-guided trapezius muscle block on the stress response and inflammatory factor levels in elderly patients with lower abdominal surgery.Methods A total of 90 elderly patientsundergoing lower abdominal surgery in Jinhua TCM Hospital Affiliated to Zhejiang Chinese Medical University from March 2021 to March 2022 were randomly divided into two groups with 45 cases in each group.Both groups were given intravenous anesthesia,the study group received additional ultrasound-guided trapezius muscle block(30 mL 0.5%lidocaine+20 mL 0.2%ropivacaine+5 mL 0.9%sodium chloride solution).The serum levels of IL-6,CRP and TNF-α;heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP),and cardiac output(CO);visual analogue scale(VAS),perioperative related indicators and adverse reactions 3 d after operation were compared between the two groups.Results After surgery 24,72 h the serum inflammatory factors(IL-6,CRP,TNF-α),the stress indexes(HR,DBP,SBP,CO)in study group were significantly lower than those in control group(all P<0.05).The VAS of pain at rest and exercise in study group was lower than that in control group(both P<0.05).Compared with the control group,the postoperative exhaust time was shorter and the postoperative walking distance was longer in the study group(all P<0.05).The incidence of adverse effects in the study group was lower than that in the control group(P<0.05).Conclusion The ultrasound-guided trapezius muscle block can effectively improve the postoperative pain,reduce the inflammatory factor levels and the stress response in elderly patients undergoing lower abdominal surgery.