腹横肌平面阻滞联合帕瑞昔布钠超前镇痛对结肠癌患者术后镇痛的影响

目的 探讨腹横肌平面(transversus abdominis plane,TAP)阻滞联合帕瑞昔布钠超前镇痛对结肠癌患者术后疼痛程度、炎性因子水平以及恢复效果的影响。 方法 选择金华市中心医院2018年9月—2019年9月收治的72例结肠癌手术患者,按照随机数表法分为TAP组与联合组,每组36例,分别运用TAP阻滞与TAP阻滞联合帕瑞昔布钠超前镇痛,对比2组的术后疼痛程度、炎性因子水平及术后恢复情况。 结果 联合组术后各时间点的VAS评分均低于TAP组(均P<0.05),2组术后的VAS评分均呈逐渐降低趋势(均P<0.05),组间与时点间有交互效应;联合组术后的肿瘤坏死因子-α、白细胞介素-6、白细胞介素-10水平分别为(19.3±3.1) ng/L、(18.8±3.3) ng/L、(171.3±13.0) ng/L,均低于TAP组的(23.6±4.0) ng/L、(21.7±3.6) ng/L、(185.5±14.3) ng/L,差异有统计学意义(t=5.098、3.563、4.408,均P<0.001);联合组的术后下床时间、初次排气时间、住院时间分别为(31.8±12.4) h、(41.2±11.9) h、(17.0±2.6) d,均短于TAP组的(40.1±13.2) h、(49.6±13.6) h、(19.6±3.1) d,差异有统计学意义(t=2.750、2.789、3.856,均P<0.05)。 结论 TAP阻滞联合帕瑞昔布钠超前镇痛在结肠癌手术患者麻醉中的运用效果显著,可明显减轻术后疼痛,降低炎性因子水平,能促进患者术后尽早恢复,值得推行。 

The effect of transverse abdominal plane block combined with parecoxib sodium in preemptive analgesia on postoperative analgesia in patients with colon cancer

Objective To explore the effect of transverse abdominal plane(TAP) block combined with parecoxib sodium preemptive analgesia on postoperative pain, inflammatory factors and recovery in patients with colon cancer. Methods Seventy-two patients with colon cancer admitted to our hospital from September 2018 to September 2019 were divided into TAP group and combination group according to the method of random number table, 36 cases in each group. Two groups were treated with TAP block and TAP block combined with parecoxib sodium for preemptive analgesia respectively. The degree of postoperative pain, inflammatory factor level and postoperative recovery were compared between the two groups. Results The VAS score of the combined group was lower than that of TAP group(P<0.05). The VAS score of the two groups decreased gradually(P<0.05). There was interaction effect between groups and time points. The levels of TNF-α, IL-6, IL-10 [(19.3±3.1) ng/L,(18.8±3.3) ng/L,(171.3±13.0) ng/L] of the combined group were lower than that of the TAP group [(23.6±4.0) ng/L,(21.7±3.6) ng/L,(185.5±14.3) ng/L], there was statistically significant difference(t=5.098, 3.563, 4.408, all P<0.001). The postoperative bed time, first exhaust time, hospitalization time [(31.8±12.4) h,(41.2±11.9) h,(17.0±2.6) d] of the combined group were shorter than the TAP group [(40.1±13.2) h,(49.6±13.6) h,(19.6±3.1) d, t=2.750, 2.789, 3.856, all P<0.05]. Conclusion The application of TAP block combined with parecoxib sodium preemptive analgesia in the anesthesia of patients undergoing colorectal cancer surgery has significant effect. It can significantly reduce postoperative pain, reduce the level of inflammatory factors, and promote the early recovery of patients after surgery, which is worthy of clinical implementation.