B超引导下腹横肌平面阻滞对老年患者腹腔镜前列腺癌根治术围术期应激反应及术后镇痛的影响(1)
[摘要] 目的 觀察B超引导腹横肌平面阻滞对老年患者腹腔镜前列腺癌根治术围术期应激反应及术后镇痛的影响，探讨其临床应用的有效性。 方法 选取2016年2月～2019年2月期间我院接收需择期行腹腔镜前列腺癌根治术老年男性患者80例，随机分为观察(R)组和对照(C)组，每组40例。R组在麻醉开始前在B超引导下应用0.1875%罗哌卡因各20 mL行双侧腹横肌平面阻滞(TAP);C组以同样方法注入等量生理盐水。两组患者术后均采用同样的静脉镇痛配方。采集两组患者静脉血，采用化学发光免疫法检测手术划皮前即刻(T1)、手术开始1 h(T2)、手术结束即刻(T3)和术后2 h(T4)的肾上腺素(E)、去甲肾上腺素(NE)、血糖(Glu)及皮质醇(Cor)浓度。记录并比较术后2 h(T5)、6 h(T6)、12 h(T7)、24 h(T8)患者的疼痛视觉模拟(VAS)评分和不良反应的发生率。 结果 两组患者T1时间E、NE、Glu和Cor浓度比较差异无统计学意义(P>0.05)，R组患者术后T2、T3和T4时间点E、NE、Glu和Cor浓度均低于C组(P<0.05)。R组患者术后各时间点(T5、T6、T7、T8)VAS评分均低于C组(P<0.05)。R组患者恶心和不良反应的总发生率低于C组(P<0.05)。 结论 在老年患者腹腔镜前列腺癌根治术术前加用B超引导腹横肌平面阻滞，不仅能减轻围术期机体应激的反应，而且镇痛效果好，不良反应少，值得在临床中大力应用推广。
[关键词] 腹横肌平面阻滞;老年患者;腹腔镜前列腺癌根治术;应激反应;术后镇痛
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2020)10-0140-05
[Abstract] Objective To observe the effect of B-ultrasound guided transversus abdominis plane block on perioperative stress response and postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy， and to explore its effect in clinical application. Methods A total of 80 elderly male patients who underwent elective laparoscopic radical prostatectomy from February 2016 to February 2019 were randomly divided into observation group(R) group and control group(C) group， with 40 cases in each group. The group R was given 20 mL of 0.1875% ropivacaine for the transversus abdominis plane block(TAP) under the guidance of B-ultrasound before the anesthesia. The group C was treated with the same amount of normal saline in the same way. Both groups of patients were given the same intravenous analgesic formula after surgery. The venous blood of the two groups was collected， and the chemoluminescence immunoassay was used to detect the concentration of adrenaline(E)， norepinephrine(NE)， blood glucose(Glu)， and cortisol(Cor) immediately before the surgery(T1)， 1 h after the operation(T2)， immediately after the operation(T3)， and 2 h after the operation(T4). The pain visual analogue(VAS) scores and the incidence of adverse events were recorded and compared between 2 h(T5)， 6 h(T6)， 12 h(T7)， and 24 h(T8) after surgery. Results There were no significant differences in concentration of E， NE， Glu and Cor between the two groups at T1(P>0.05). The concentration of E， NE， Glu and Cor in the group R was lower than that in the group C at the T2， T3 and T4 time points after surgery(P<0.05). The VAS scores of patients in group R were lower than those in group C at each time point(T5， T6， T7， T8) after treatment(P<0.05). The overall incidence of nausea and adverse reactions in the group R was lower than that in the group C(P<0.05). Conclusion The addition of B-ultrasound guided abdominal transverse muscle plane block in the elderly patients with laparoscopic radical prostatectomy not only can reduce the perioperative body stress response， but also has good analgesic effect and less adverse reactions， which is worthy of clinical application and promotion., 百拇医药(马旭杰 李平 李红)
[关键词] 腹横肌平面阻滞;老年患者;腹腔镜前列腺癌根治术;应激反应;术后镇痛
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2020)10-0140-05
[Abstract] Objective To observe the effect of B-ultrasound guided transversus abdominis plane block on perioperative stress response and postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy， and to explore its effect in clinical application. Methods A total of 80 elderly male patients who underwent elective laparoscopic radical prostatectomy from February 2016 to February 2019 were randomly divided into observation group(R) group and control group(C) group， with 40 cases in each group. The group R was given 20 mL of 0.1875% ropivacaine for the transversus abdominis plane block(TAP) under the guidance of B-ultrasound before the anesthesia. The group C was treated with the same amount of normal saline in the same way. Both groups of patients were given the same intravenous analgesic formula after surgery. The venous blood of the two groups was collected， and the chemoluminescence immunoassay was used to detect the concentration of adrenaline(E)， norepinephrine(NE)， blood glucose(Glu)， and cortisol(Cor) immediately before the surgery(T1)， 1 h after the operation(T2)， immediately after the operation(T3)， and 2 h after the operation(T4). The pain visual analogue(VAS) scores and the incidence of adverse events were recorded and compared between 2 h(T5)， 6 h(T6)， 12 h(T7)， and 24 h(T8) after surgery. Results There were no significant differences in concentration of E， NE， Glu and Cor between the two groups at T1(P>0.05). The concentration of E， NE， Glu and Cor in the group R was lower than that in the group C at the T2， T3 and T4 time points after surgery(P<0.05). The VAS scores of patients in group R were lower than those in group C at each time point(T5， T6， T7， T8) after treatment(P<0.05). The overall incidence of nausea and adverse reactions in the group R was lower than that in the group C(P<0.05). Conclusion The addition of B-ultrasound guided abdominal transverse muscle plane block in the elderly patients with laparoscopic radical prostatectomy not only can reduce the perioperative body stress response， but also has good analgesic effect and less adverse reactions， which is worthy of clinical application and promotion., 百拇医药(马旭杰 李平 李红)
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