[1]李静,杨红军.超声引导下双侧腹横肌平面阻滞复合全身麻醉在宫颈癌手术中的应用效果[J].新乡医学院学报,2023,40(7):653-658.[doi:10.7683/xxyxyxb.2023.07.010]
　LI Jing,YANG Hongjun.Application effect of ultrasound-guided bilateral transversus abdominis plane block combined with general anesthesia in cervical cancer surgery[J].Journal of Xinxiang Medical University,2023,40(7):653-658.[doi:10.7683/xxyxyxb.2023.07.010]
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超声引导下双侧腹横肌平面阻滞复合全身麻醉在宫颈癌手术中的应用效果
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年7
页码:
653-658
栏目:
临床研究
出版日期:
2023-07-05

文章信息/Info

Title:
Application effect of ultrasound-guided bilateral transversus abdominis plane block combined with general anesthesia in cervical cancer surgery
作者:
李静; 杨红军
（焦作市妇幼保健院麻醉与围术期医学科，河南　焦作　454000）
Author(s):
LI Jing; YANG Hongjun
(Department of Anesthesia and Perioperative Medicine,Maternal and Child Health Hospital of Jiaozuo City,Jiaozuo 454000,Henan Province,China)
关键词:
宫颈癌; 超声引导下的双侧腹横肌平面阻滞; 血流动力学; 应激反应; 疼痛
Keywords:
uterine cervical carcinoma; ultrasound-guided bilateral transversus abdominis plane block; hemodynamics; stress response; pain
分类号:
R737.33
DOI:
10.7683/xxyxyxb.2023.07.010
文献标志码:
A
摘要:
目的　探讨超声引导下双侧腹横肌平面（TAP）阻滞复合全身麻醉在宫颈癌（UCC）手术中的应用效果。
方法　选择2020年2月至2022年2月于焦作市妇幼保健院行UCC手术患者132例为研究对象，采用随机数字表法将患者分为观察组（n=66）和对照组（n=66）。对照组患者给予全身麻醉,观察组患者给予超声引导下双侧TAP阻滞复合全身麻醉。记录2组患者入室时（T1）、实施麻醉时（T2）、切皮时（T3）、术毕（T4）的平均动脉压（MAP）和心率（HR）。分别于T1、T2、T3、T4时采用化学发光免疫分析法检测2组患者血清中皮质醇（Cor）和白细胞介素-6（IL-6）水平；分别于术后6、24、48 h时采用视觉模拟评分法（VAS）评估2组患者的疼痛情况。记录2组患者术后肛门排气时间、首次下床活动时间和术后48 h恶心呕吐、呼吸抑制等并发症发生情况。
结果　2组患者T2、T3、T4时的MAP、HR均低于T1时（P<0.05）；2组患者T2、T3、T4时的MAP两两比较差异均无统计学意义（P>0.05）。2组患者T3时的HR均显著低于T2时,T4时的HR均显著高于T3时（P<0.05）。2组患者T2与T4时HR比较差异无统计学意义（P>0.05）。 T1、T4时，2组患者的MAP、HR比较差异无统计学意义（P>0.05）；T2、T3时，观察组患者的MAP显著高于对照组（P<0.05）；T2时，观察组患者的HR显著高于对照组（P<0.05）；T3时，2组患者的HR比较差异无统计学意义（P>0.05）。2组患者T2、T3、T4时血清Cor、IL-6水平均显著高于T1时（P<0.05）。对照组患者T2、T3、T4时血清Cor水平比较差异均无统计学意义（P>0.05）；对照组患者T3、T4时血清IL-6水平显著高于T2时，T4时血清IL-6水平显著低于T3时（P<0.05）。观察组患者T3、T4时血清Cor水平与T2时比较差异无统计学意义（P>0.05）；T4时血清Cor水平显著低于T3时（P<0.05）。观察组患者T3时血清IL-6水平显著高于T2时，T4时血清IL-6水平显著低于T3时（P<0.05）；观察组患者T2、T4时血清IL-6水平比较差异无统计学意义（P>0.05）。T1时，2组患者血清Cor、IL-6水平比较差异无统计学意义（P>0.05）；T2、T3、T4时，观察组患者血清Cor、IL-6水平显著低于对照组（P<0.05）。 2组患者术后24、48 h的VAS评分显著低于术后6 h（P<0.05），术后48 h的VAS评分显著低于术后24 h（P<0.05）。观察组患者术后6、24 h的VAS评分显著低于对照组（P<0.05），2组患者术后48 h VAS评分比较差异无统计学意义（P>0.05）。观察组患者术后肛门排气时间、首次下床活动时间均显著短于对照组（P<0.05）。术后48 h，观察组和对照组患者并发症发生率分别为7.58%（5/66）、21.21%（14/66）；观察组患者术后并发症发生率显著低于对照组（χ2=4.980，P<0.05）。
结论　超声引导下双侧TAP阻滞复合全身麻醉可维持UCC手术患者血流动力学稳定，降低应激反应和血清中IL-6水平，加速患者术后康复，且术后并发症较少。
Abstract:
Objective　To investigate the application effect of ultrasound-guided bilateral transversus abdominis plane(TAP) block combined with general anesthesia in patients with uterine cervical carcinoma(UCC).
Methods　A total of 132 patients who underwent UCC surgery in Maternal and Child Health Hospital of Jiaozuo City from February 2020 to February 2022 were selected as the research subjects.They were divided into observation group(n=66) and control group(n=66) by random number table method.The patients in the control group were given general anesthesia,the patients in the observation group were given bilateral TAP block under ultrasound guidance combined with general anesthesia.The mean arterial pressure(MAP) and heart rate(HR) of patients in the two groups were recorded at the time point of entering the operating room(T1),anesthesia(T2),skin incision(T3) and the end of operation(T4).The serum cortisol(Cor) and interleukin-6(IL-6) levels of patients in the two groups were determined by chemiluminescence immunoassay at T1,T2,T3 and T4,respectively;the pain status of patients in the two groups was evaluated by visual analogue scale(VAS) at 6,24,48 h after operation.The time of anal exhaust,the time of getting out of bed for the first time and the complications such as nausea,vomiting,and respiratory suppression of patients at 48 hours after operation were recorded.
Results　The MAP and HR of patients in the two groups at T2,T3,and T4 time point were significantly lower than those at T1(P<0.05).There was no significant difference in MAP of patients in the two groups among T2,T3,and T4 time point(P>0.05).The HR of patients in the two groups at T3 was significant lower than that at T2,while the HR at T4 was significant higher than that at T3(P<0.05).There was no significant difference in HR of patients in the two groups between T2 and T4 time point(P>0.05).At T1 and T4 time point,there was no significant difference in MAP and HR of patients between the two groups(P>0.05).At T2 and T3 time point,the MAP of patients in the observation group was significantly higher than that in the control group(P<0.05);at T2 time point,the HR of patients in the observation group was significantly higher than that in the control group(P<0.05);at T3 time point,there was no significant difference in HR of patients between the two groups(P>0.05).The serum Cor and IL-6 levels of patients in the two groups at T2,T3 and T4 were significantly higher than those at T1(P<0.05).In the control group,there was no significant difference in serum Cor level of patients among T2,T3 and T4(P>0.05);the serum IL-6 level of patients in the control group at T3 and T4 was significantly higher than that at T2,while the serum IL-6 level at T4 was significantly lower than that at T3(P<0.05).In the observation group,there was no significant difference in serum Cor level of patients between T3,T4 and T2(P>0.05);the serum Cor level at T4 was significantly lower than that at T3(P<0.05);the serum IL-6 level of patients at T3 was significantly higher than that at T2,and the serum IL-6 level at T4 was significantly lower than that at T3(P<0.05);there was no significant difference in serum IL-6 level of patients between T2 and T4(P>0.05).At T1,there was no significant difference in serum Cor and IL-6 levels of patients between the two groups(P>0.05);at T2,T3 and T4,the serum Cor and IL-6 levels of patients in the observation group were significantly lower than those in the control group(P<0.05).The VAS scores of patients in the two groups at 24,48 h after operation were significantly lower than those at 6 h after operation(P<0.05),and the VAS scores at 48 h after operation were significantly lower than those at 24 h after operation(P<0.05).At 48 h after operation,there was no significant difference in VAS scores of patients in the two groups(P>0.05).The time of anal exhaust and the time of getting out of bed for the first time of patients in the observation group were shorter than those in the control group(P<0.05).At 48 h after operation,the incidence of postoperative complications of patients in the observation group and the control group was 7.58%(5/66),21.21%(14/66),respectively;the incidence of postoperative complications of patients in the observation group was significantly lower than that in the control group（χ2=4.980，P<0.05）.
Conclusion　Ultrasound-guided bilateral TAP block combined with general anesthesia can maintain hemodynamic stability,reduce stress response and the serum IL-6 level,accelerate postoperative rehabilitation and reduce postoperative complications of patients undergoing UCC.

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更新日期/Last Update: 2023-07-05