【摘要】：目的觀察B超引導(dǎo)腹橫肌平面阻滯應(yīng)用于老年患者腹腔鏡直腸癌根治術(shù)后鎮(zhèn)痛效果及對機(jī)體免疫功能的影響。方法60例需行腹腔鏡直腸癌根治術(shù)的老年患者,按照入院順序編號采取數(shù)字隨機(jī)法分為腹橫肌平面阻滯組及生理鹽水對照組。腹橫肌平面阻滯組于全麻誘導(dǎo)后行B超引導(dǎo)腹橫肌平面阻滯,靜注0.25%鹽酸羅哌卡因30 ml;生理鹽水對照組靜注等容量生理鹽水。術(shù)后均給予靜脈鎮(zhèn)痛泵:舒芬太尼1.00μg/kg+昂丹司瓊16.00 mg+地佐辛10.00 mg+生理鹽水配置成100 ml,設(shè)置2 ml/h,自控時間15 min。觀察兩組麻醉前(T_0)、術(shù)后1 h(T_1)、術(shù)后12 h(T_2)、術(shù)后24 h(T_3)及術(shù)后48 h(T_4)的視覺模擬評分(VAS)及血流動力學(xué)相關(guān)指標(biāo);記錄術(shù)后24 h鎮(zhèn)痛泵按壓次數(shù)及舒芬太尼使用總量;并抽取靜脈血采取流式細(xì)胞儀測定CD4~+%、CD8~+%水平,應(yīng)用酶聯(lián)免疫吸附法測定γ干擾素(IFN-γ)水平;比較兩組術(shù)后不良反應(yīng)。結(jié)果與生理鹽水對照組比較,腹橫肌平面阻滯組于T_1和T_2時點平均動脈壓(MAP)降低,T_1、T_2及T_3時點心率(HR)降低(均P0.05);腹橫肌平面阻滯組組內(nèi)比較,T_1時點MAP高于T_0時點,T_1和T_2時點HR高于T_0時點(均P0.05)。與生理鹽水對照組比較,腹橫肌平面阻滯組于T_1、T_2、T_3和T_4時點VAS評分均更低,且術(shù)后24 h按壓次數(shù)及舒芬太尼總量均降低(均P0.05),CD4~+%水平均升高,IFN-γ水平T_2和T_3時點均升高(均P0.05);不良反應(yīng)發(fā)生率降低(P0.05)。結(jié)論B超引導(dǎo)腹橫肌平面阻滯應(yīng)用于老年患者腹腔鏡直腸癌根治術(shù)后鎮(zhèn)痛效果較佳,血流動力學(xué)平穩(wěn),術(shù)后疼痛程度更低,對機(jī)體免疫能力具有一定保護(hù)作用,且不良反應(yīng)發(fā)生率低,臨床應(yīng)用安全。
[Abstract]:Objective to observe the analgesic effect and effect on immune function of abdominal transverse muscle plane block guided by B-ultrasound in elderly patients after laparoscopic radical resection of rectal cancer. Methods Sixty elderly patients undergoing laparoscopic radical resection of rectal cancer were randomly divided into abdominal transverse muscle plane block group and saline control group according to the order of admission. In the abdominal transverse muscle plane block group, B-ultrasound guided abdominal transverse muscle plane block was induced by general anesthesia, and 0.25% ropivacaine hydrochloride 30 ml; saline control group was injected intravenously with the same volume of saline. All patients were given intravenous analgesia pump: sufentanil 1.00 渭 g / kg ondansetron 16.00 mg dizoxacin 10.00 mg saline was assigned to 100 ml, for 2 ml/h, automatic control time 15 min. The visual simulation scores (VAS) and hemodynamic indexes were observed before anesthesia (T 鈮，

本文編號：2508020