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目的观察超声引导下腹横肌平面阻滞与术中目标导向液体治疗联合应用对腹腔镜肠癌根治术患者术后快速康复的影响。方法随机将80名择期行腹腔镜结肠癌根治术的患者分为目标导向液体治疗组(G组,n=20)、腹横肌阻滞组(T组,n=20)、联合组(GT组,n=20)和对照组(C组,n=20)。G组以每博变异度(SVV)、中心静脉压(CVP)为依据,心指数(CI)≥2.5 L·min~(-1)·m~(-2)为目标,使用胶体反应法和正性肌力药物行液体导向治疗;T组以超声为引导,以四点法行腹横肌平面阻滞,液体管理同对照组。GT组同时给予目标导向液体治疗及超声引导下腹横肌平面阻滞治疗。C组则按常规方法行补液治疗,维持CVP于8-15mm Hg;若CVP>15mm Hg,MAP<60mm Hg,则使用多巴酚丁胺,直至MAP>60mm Hg。术毕记录各组阿片类药物、多巴酚丁胺使用时间、液体出入量、拔管时间、PACU停留时间及VAS评分。比较各组术后30d内并发症发生率和病人的满意度、术后住院时间及费用、术后恶心呕吐的频率、胃肠道功能恢复情况、术后可离床时间。结果 GT组术中阿片类药物用量及血管活性药物应用时间、拔管时间、PACU停留时间、VAS评分、术后30d并发症、住院时间、费用及POVN发生率显著低于其他三组(#P<0.01)。胃肠蠕动及术后可离床时间亦显著短于其余各组(#P<0.01)。结论腹横肌平面阻滞联合目标导向液体治疗用于腹腔镜结肠癌手术,能显著减少术后并发症的发生,促进病人的康复,减少住院时间及费用,从而达到术后快速康复(Enhanced Recovery After Surgery,ERAS)的效果。
Objective To observe the effect of ultrasonography-guided transversal abdominal block in combination with targeted fluid therapy on the rapid recovery of patients undergoing laparoscopic radical resection of gastrectomy. Methods Totally 80 patients who underwent radical laparoscopic radical resection of colon cancer were randomly divided into three groups: target-directed fluid therapy group (group G, n = 20), transversus abdominis muscle block group (group T, n = 20) Group, n = 20) and control group (group C, n = 20). G group was based on SVV and CVP, and the cardiac index (CI) was ≥2.5 L · min -1 (m -2). Colloid reaction method and positive Inotropic therapy was guided by liquid; in T group, ultrasound was used as a guide, and the four-point method was used to block the transverse abdominal muscle. The fluid management was the same as that of the control group. GT group also given the target-oriented liquid therapy and ultrasound-guided lateral abdominal block plane block treatment. In group C, rehydration therapy was performed according to the conventional method, and CVP was maintained at 8-15 mm Hg. If CVP> 15 mm Hg, MAP <60 mm Hg, dobutamine was used until MAP> 60 mm Hg. The postoperative recordings of opioids, dobutamine use time, fluid intake and discharge, extubation time, PACU stay time and VAS score were recorded. The complication rates, patient satisfaction, postoperative hospitalization time and cost, postoperative nausea and vomiting frequency, gastrointestinal function recovery and postoperative bed release time were compared between the two groups. Results The intraoperative opioid dosage, vasoactive drug application time, extubation time, PACU stay time, VAS score, postoperative 30d complication, hospitalization time, cost and POVN incidence in GT group were significantly lower than those in the other three groups (#P <0.01). Gastrointestinal peristalsis and postoperative ambulation time were also significantly shorter than the other groups (#P <0.01). Conclusions Transverse abdominoplasty combined with target-directed fluid therapy for laparoscopic colon cancer surgery can significantly reduce the incidence of postoperative complications, promote patient rehabilitation, reduce hospitalization time and costs, and achieve postoperative recovery After Surgery, ERAS).