超声引导下腹横肌平面阻滞与腰方肌阻滞在直肠癌患者腹腔镜手术中的应用

贺杰; 孙睿; 王振红; 谢欣怡

doi:10.7619/jcmp.20214629

超声引导下腹横肌平面阻滞与腰方肌阻滞在直肠癌患者腹腔镜手术中的应用

Application of ultrasound-guided transversus abdominis plane block and quadratus lumborum block in patients with rectal cancer undergoing laparoscopic surgery

摘要

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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