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目的观察B超引导腹横肌平面阻滞应用于腹腔镜直肠癌根治术老年患者术后镇痛效果及对患者免疫功能的影响。方法将60例腹腔镜直肠癌根治术老年患者随机分为2组,腹横肌平面阻滞组于全麻诱导后行B超引导腹横肌平面阻滞,静注0.25%盐酸罗哌卡因30 ml;生理盐水对照组静注等容量生理盐水。观察2组麻醉前(T0)、术后1 h(T1)、术后12 h(T2)、术后24 h(T3)及术后48 h(T4)视觉模拟评分(VAS评分)及血流动力学指标;记录术后24 h镇痛泵按压次数及舒芬太尼使用总量;比较CD4~+%、CD8~+%、IFN-γ水平及不良反应。结果与生理盐水对照组比较,腹横肌平面阻滞组于T1、T2时点MAP降低,T1、T2及T3时点HR降低(均P<0.05)。与生理盐水对照组比较,腹横肌平面阻滞组于T1、T2、T3、T4时点VAS评分均更低,且术后24 h按压次数及舒芬太尼总量均降低(均P<0.05)。与生理盐水对照组比较,腹横肌平面阻滞组T1、T2、T3及T4时点CD4~+%水平均升高,IFN-γ水平T2、T3时点均升高(均P<0.05)。与生理盐水对照组比较,腹横肌平面阻滞组不良反应发生率降低(P<0.05)。结论 B超引导腹横肌平面阻滞应用于腹腔镜直肠癌根治术老年患者术后镇痛效果较佳,血流动力学平稳,且对免疫功能具有保护作用,不良反应发生率低。
Objective To observe the postoperative analgesic effect and its effect on the immune function of elderly patients undergoing laparoscopic radical mastectomy for the treatment of laparoscopic radical resection. Methods Sixty elderly patients undergoing laparoscopic radical resection of rectal cancer were randomly divided into two groups. The patients were divided into two groups randomly. After the induction of general anesthesia, B-guided transthoracic horizontal plane block was induced. After intravenous injection of 0.25% ropivacaine hydrochloride 30 ml; saline control group intravenous infusion of normal saline. The visual analog scale (VAS score) and blood flow (VAS score) of two groups before anesthesia (T0), 1 h after operation (T1), 12 h after operation (T2), 24 h after operation (T3) and 48 h Kinetic indexes were recorded. The number of analgesia pump press and total sufentanil usage were recorded 24 hours after operation. The levels of CD4 ~ +%, CD8 ~ +%, IFN-γ and adverse reactions were recorded. Results Compared with the saline control group, the MAP of the FP group was decreased at T1 and T2, and decreased at T1, T2 and T3 (all P <0.05). Compared with the saline control group, the VAS score at T1, T2, T3 and T4 points were lower in the transverse abdominal muscle block group, and the numbers of pressing and sufentanil at 24 h after operation were lower (all P < 0.05). The levels of CD4 ~ +% at T1, T2, T3 and T4 in the transverse abdominal muscle block group were all higher than those in the saline control group, and the levels of IFN-γ at T2 and T3 were significantly increased (all P <0.05) . Compared with the saline control group, the incidence of adverse reactions in the transverse abdominal block group decreased (P <0.05). Conclusion B-guided transversal transverse plane blockade in elderly patients undergoing laparoscopic radical resection of rectal cancer has better postoperative analgesia, stable hemodynamics, and has a protective effect on immune function with a low incidence of adverse reactions.