摘要
目的探讨超声引导下腹横肌平面阻滞(TAPB)对腹腔镜结肠癌手术患者应激反应及免疫功能的影响。方法腹腔镜结肠癌手术患者32例随机均分为两组:T组麻醉诱导后超声引导下采用0.375%罗哌卡因20ml行双侧TAPB;C组则给予等量生理盐水。评估术后VAS疼痛评分,记录镇痛镇静药用量,观察并发症发生情况;于麻醉前、术后2、12、24和48h检测外周血C反应蛋白(CRP)、皮质醇、T淋巴细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)及自然杀伤细胞的水平。结果与C组比较,T组芬太尼用量减少,术后4、8hVAS疼痛评分降低,舒适度评分高,术后12、24、48h血清CRP、皮质醇水平降低,CD4^+、CD4^+/CD8^+比值增高(P均<0.05)。结论超声引导下TAPB能改善腹腔镜结肠癌手术患者术后免疫功能,可能与其减轻术后疼痛和机体应激反应有关。
Objective To study the influence of ultrasound-guided transversus abdominis plane block（TAPB） on the stress response and immune function in the patients undergoing laparoscopic colon cancer surgery. Methods Thirty-two patients undergoing laparoscopic colon cancer surgery were equally randomized into two groups of T （received ultrasound-guided TAPB with 0. 375% ropivacaine 20 ml after anesthesia induction） and C（received equivalent normal saline as the control）. VAS pain scores were evaluated, the consumption of analgesics was calculated and relevant complications were observed. Serum levels of C-reactive protein （CRP）, cortisol, subgroups of T-lymphocyte（CD4＋ , CD8＋ and CD4＋/CD8＋ ratio） and natural killer cells in peripheral venous blood were tested before anesthesia and at 2,12,24 and 48 hours after surgery. Results Compared to group C, the dosage of fentanyl used for postoperative analgesia, VAS pain scores at 4 and 8 hours and serum CRP and cortisol at 12,24 and 48 hours after the surgery were decreased, while BCS score at 4 and 8 hours and the values of CD4＋ and CD4＋/CD8＋ ratio at 12,24 and 48 hours after operation were increased in group T （P〈0. 05）. Conclusion Ultrasound-guided TAPB can improve postoperative immune function of the patients undergoing laparoscopic colon cancer surgery, which may be related to the attenuation of postoperative pain and stress response.
出处
《江苏医药》
CAS
2016年第3期277-280,共4页
Jiangsu Medical Journal
关键词
腹横肌平面阻滞
腹腔镜结肠癌手术
应激反应
免疫功能
Transversus abdominis plane block
Laparoscopic colon cancer surgery
Stress response
Immune function
