超声引导下腹直肌后鞘阻滞联合腹横肌阻滞对开腹结直肠癌术患者应激反应的影响

目的 探讨超声引导下腹直肌后鞘阻滞联合腹横肌阻滞在开腹结直肠癌术患者中的应用效果及对应激反应的影响。 方法 选择2017年1月—2018年6月开腹结直肠癌术患者82例，采用随机数字表法分为对照组和观察组各41例。对照组给予全身麻醉，观察组全身麻醉复合超声引导下腹直肌后鞘阻滞联合腹横肌阻滞，手术完毕对患者麻醉效果进行评估。统计2组镇痛泵按压次数、舒芬太尼总用量、肛门排气时间、开始下床活动时间；采用酶联免疫吸附试验(ELISA)检测患者血清皮质醇(CORT)、儿茶酚胺(CA)、血浆谷氨酸(GLU)水平；统计并记录2组恶心呕吐、肝挫伤、脾挫伤、穿刺点感染、寒战及心动过缓发生率。 结果 观察组镇痛泵按压次数、舒芬太尼总用量、肛门排气时间、开始下床活动时间，均少(短)于对照组(均P<0.05)；观察组与对照组T1、T2时间点CORT、CA、GLU水平均高于T0时间点(均P<0.05)；观察组T1、T2时间点CORT、CA、GLU水平均低于对照组(均P<0.05)；观察组与对照组麻醉后恶心呕吐、头痛眩晕、穿刺点感染、寒战及心动过缓发生率差异无统计学意义(均P>0.05)。 结论 超声引导下腹直肌后鞘阻滞联合腹横肌阻滞在开腹结直肠癌术患者中能缩短症状改善时间，降低舒芬太尼药物使用剂量及应激反应，安全性较高，值得推广应用。 

Effect of ultrasound-guided posterior rectus sheath and transverse abdominis block on stress response in patients undergoing open colorectal cancer

Objective To investigate the effect of ultrasound-guided posterior rectus sheath and transverse abdominis block in patients with open colorectal cancer and its effect on stress response. Methods Eighty-two patients with open colorectal cancer were enrolled between January 2017 and June 2018. They were divided into control group and observation group with 41 cases in each group. The control group was given general anesthesia. On the basis of which, the observation group was given the ultrasound-guided posterior rectus abdominis and the transverse abdominis block. The anesthesia effect was evaluated after the operation. The number of analgesic pump presses, the total dose of sufentanil, the time of anal exhaust, and the time of getting out of bed were counted. Serum cortisol (CORT) and catecholamine (CA) were obtained by enzyme-linked immunosorbent assay (ELISA). Plasma glutamate (GLU) levels, the incidence of nausea and vomiting, hepatic contusion, spleen contusion, puncture infection, chills and bradycardia in the two groups were counted and recorded, comparing the effects of anesthesia and stress on the two groups. Results The number of analgesic pump presses, the total dose of sufentanil, the time of anal exhaust, and the time of getting out of bed were all less (shorter) than the control group (all P<0.05); the observation group and the control group T1, T2 The levels of CORT, CA and GLU were higher than the T0 time point (all P<0.05). The levels of CORT, CA and GLU in the observation group at T1 and T2 were lower than those in the control group (all P<0.05). There was no significant difference in the incidence of nausea and vomiting, headache, dizziness, puncture infection, chills and bradycardia after anesthesia (all P>0.05). Conclusion Ultrasound-guided posterior rectus sheath combined with transverse abdominis block can shorten the symptom improvement time and reduce the dose and stress response of sufentanil in patients with open colorectal cancer. It is worth promoting.