Application of ultrasound-guided transversus abdominis plane block and quadratus lumborum block in patients with rectal cancer undergoing laparoscopic surgery
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摘要:目的 比较超声引导下腹横肌平面阻滞(TAPB)与腰方肌阻滞(QLB)在直肠癌患者腹腔镜手术中的应用效果。方法 选取接受腹腔镜手术治疗的94例直肠癌患者为研究对象，随机分为观察组47例和对照组47例。观察组实施超声引导下QLB, 对照组实施超声引导下TAPB。比较2组术后舒芬太尼用量、疼痛程度[视觉模拟评分法(VAS)]及不良反应发生率; 比较2组手术前后血清5-羟色胺(5-HT)、P物质(SP)、前列腺素E2(PGE2)水平变化。结果 术后2、8、12、24 h, 观察组舒芬太尼累计使用量少于对照组, VAS评分低于对照组，差异有统计学意义(P < 0.05)。术后24 h, 2组血清5-HT、SP、PGE2水平均高于术前，同时观察组低于对照组，差异有统计学意义(P < 0.05)。术后，观察组不良反应发生率为10.64%, 低于对照组的27.66%, 差异有统计学意义(P < 0.05)。结论 相较于超声引导下TAPB, 超声引导下QLB在直肠癌患腹腔镜手术中应用效果更佳，可有效减轻患者术后疼痛，降低疼痛介质水平和不良反应发生率，并减少其他麻醉药物使用。Abstract:Objective To compare the application effects of ultrasound-guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in laparoscopic surgery for patients with rectal cancer.Methods A total of 94 patients with rectal cancer undergoing laparoscopic surgery were selected as research objects, and were randomly divided into observation group (n=47) and control group (n=47). The observation group was given ultrasound-guided QLB, and the control group was given ultrasound-guided TAPB. The dosage of sufentanil, the degree of pain [Visual Analogue Scale (VAS)] and the incidence of adverse reactions were compared between the two groups. The serum levels of 5-hydroxytryptamine (5-HT), substance P (SP) and prostaglandin E2 (PGE2) were compared between the two groups before and after operation.Results At 2, 8, 12 and 24 h after surgery, the cumulative use of sufentanil in the observation group was significantly lower than that in the control group, and VAS score was significantly lower than that in the control group (P < 0.05). At 24 h after operation, the levels of 5-HT, SP and PGE2 in both groups were significantly higher than those before operation, while those in the observation group were significantly lower than the control group (P < 0.05). The incidence of adverse reactions in the observation group was 10.64%, which was significantly lower than 27.66% in the control group (P < 0.05).Conclusion Compared with ultrasound-guided TAPB, ultrasound-guided QLB has a better application effect in laparoscopic surgery for rectal cancer, which can effectively relieve postoperative pain, reduce the level of pain mediators and the incidence of adverse reactions, and reduce the use of other anesthetics.
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表 1 2组一般资料比较(x±s)
组别 n 性别/例 年龄/岁 体质量指数/(kg/m2) 手术时间/min 美国麻醉医师协会分级/例 男 女 Ⅰ级 Ⅱ级 Ⅲ级 观察组 47 31 16 69.25±4.81 22.16±1.35 149.72±25.84 12 27 8 对照组 47 30 17 68.76±4.93 22.08±1.37 146.31±23.67 11 29 7 
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表 2 2组术后不同时点舒芬太尼累计用量比较(x±s)
μg 组别 n 术后2 h 术后8 h 术后12 h 术后24 h 观察组 47 4.27±0.65* 11.29±2.36* 20.43±4.79* 26.51±5.17* 对照组 47 5.08±0.73 14.15±2.48 28.17±5.25 38.62±6.44 与对照组比较, *P < 0.05。
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表 3 2组患者术后不同时点疼痛程度评分比较(x±s)
分 组别 n 术后2 h 术后8 h 术后12 h 术后24 h 观察组 47 1.17±0.28* 2.08±0.43* 1.82±0.39* 1.51±0.32* 对照组 47 1.32±0.31 2.49±0.48 2.26±0.45 1.98±0.37 与对照组比较, *P < 0.05。
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表 4 2组患者术前、术后24 h血清5-羟色胺、P物质、前列腺素E2水平比较(x±s)
组别 n 5-羟色胺/(ng/mL) P物质/(ng/L) 前列腺素E2/(ng/L) 术前 术后24 h 术前 术后24 h 术前 术后24 h 观察组 47 68.71±8.53 119.46±12.73*# 25.83±4.96 98.62±9.07*# 187.52±19.48 369.82±27.13*# 对照组 47 66.35±8.27 136.29±15.81* 25.19±4.82 112.75±12.68* 185.17±19.01 405.69±31.84* 与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组术后不良反应发生率比较[n(%)]
组别 n 心动过速 恶心呕吐 皮肤瘙痒 头晕 合计 观察组 47 0 2(4.26) 1(2.13) 2(4.26) 5(10.64)* 对照组 47 1(2.13) 5(10.64) 3(6.38) 4(8.51) 13(27.66) 与对照组比较, *P < 0.05。
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[1] 王锡山. 中美结直肠癌流行病学特征对比及防控策略分析[J]. 中华结直肠疾病电子杂志, 2019, 8(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZC201901002.htm [2] 张庆兵, 吴玥, 牛居辉. 超声引导腰方肌阻滞与腹横肌平面阻滞对剖宫产术后镇痛效果的影响[J]. 皖南医学院学报, 2020, 39(1): 68-71. https://www.cnki.com.cn/Article/CJFDTOTAL-WNYX202001018.htm [3] 中华医学会消化病学分会. 中国结直肠肿瘤筛查、早诊早治和综合预防共识意见(一)[J]. 中华消化杂志, 2012, 32(1): 1-10. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC201111010.htm [4] 陈昕涛. 结直肠癌腹腔镜手术治疗的研究进展[J]. 东南国防医药, 2020, 22(3): 283-288. doi: 10.3969/j.issn.1672-271X.2020.03.013 [5] MOLFINO S, BOTTERI E, BAGGI P, et al. Pain control in laparoscopic surgery: a case-control study between transversus abdominis plane-block and trocar-site anesthesia[J]. Updates Surg, 2019, 71(4): 717-722. doi: 10.1007/s13304-018-00615-y
[6] CHOI H R, OH T K, KIM J, et al. Analgesia after major laparoscopic surgery in patients with chronic kidney disease: a retrospective cohort study[J]. Sci Rep, 2019, 9(1): 3939. doi: 10.1038/s41598-019-40627-1
[7] KIM T E, GANAWAY T, HARRISON T K, et al. Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training[J]. Korean J Anesthesiol, 2017, 70(3): 318-326. doi: 10.4097/kjae.2017.70.3.318
[8] 朱洁, 马家玲, 高艳平. 超声引导下腰方肌阻滞与腹横肌平面阻滞对胃癌根治术老年患者术后镇痛效果[J]. 贵州医药, 2019, 43(9): 1368-1371. doi: 10.3969/j.issn.1000-744X.2019.09.007 [9] KROHG A, ULLENSVANG K, ROSSELAND L A, et al. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial[J]. Anesth Analg, 2018, 126(2): 559-565. doi: 10.1213/ANE.0000000000002648
[10] 冒江旗, 曹苏. 胆囊结石合并胆囊炎患者腹腔镜胆囊切除术后应用腰方肌阻滞和腹横肌平面阻滞的镇痛效果比较[J]. 医学临床研究, 2020, 37(1): 126-128. [11] 任柏林, 冯爱敏, 乔迎帅, 等. 腰方肌与腹横肌平面阻滞在腹腔镜手术中的镇痛效果比较[J]. 新乡医学院学报, 2018, 35(8): 719-721. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201808021.htm [12] 谢颖, 李林佶, 任普圣, 等. 超声引导下腰方肌阻滞与腹横肌平面阻滞在腹股沟疝无张力疝修补术中麻醉效果的比较[J]. 中国老年学杂志, 2020, 40(1): 95-98. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202001032.htm [13] 康文彬, 李颖源, 周雪, 等. 腹横肌平面阻滞和腰方肌阻滞的效果对比[J]. 临床外科杂志, 2019, 27(6): 456-459. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK201906003.htm [14] 刘军, 周颖, 蔡志勇, 等. 氯胺酮复合氟比洛芬酯超前镇痛对乳腺癌根治术患者术后疼痛介质及心血管反应的影响[J]. 河北医学, 2019, 25(10): 1658-1663. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX201910019.htm [15] 昝望, 潘鑫, 熊苗苗, 等. 术前高度焦虑相关致痛因子的变化及其对术后疼痛的影响[J]. 临床麻醉学杂志, 2018, 34(8): 768-772. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201808012.htm -
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