全麻联合区域神经阻滞对结直肠癌腹腔镜手术患者应激反应及镇痛效果的影响

目的]探讨全身麻醉联合区域神经阻滞对结直肠癌腹腔镜手术患者术后应激反应、炎症反应、镇痛效果的影响.方法]90例结直肠癌患者随机分为三组,各30例,A组行单纯静脉麻醉,B组行全麻复合硬膜外阻滞,C组行全麻联合腹横肌平面阻滞,比较三组麻醉情况,三组切皮即刻(T0)、切皮后5 min(T1)、术毕(T2)各时点平均动脉压(MAP)、心率(HR),术中、术后皮质醇(Cor)及炎症因子(白介素-6(IL-6)、肿瘤坏死因子(TNF-α)]水平,术后疼痛及并发症情况.结果]三组住院时间、卧床时间为C组>B组>A组(P<0.05);B、C组丙泊酚与芬太尼用量少于A组(P<0.05),MAP、HR在T0~T2时间段增加幅度小于A组(P<0.05);C组术后Cor、IL-6、TNF-α较A、B组明显增加(P<0.05),术后6 h、12 h VAS评分均小于A、B组(P<0.05);C组并发症发生率为3.33%,明显低于A组23.33%和B组20.00%(P<0.05).结论]全麻联合区域神经阻滞可明显减少结直肠癌腹腔镜手术患者应激反应、炎症反应及疼痛度,减少麻醉剂用量.

Effect of General Anesthesia Combined with Regional Nerve Block on Stress Response in Patients with Colorectal Cancer Surgery and Analgesia

Objective]To investigate the effect of general anesthesia combined with regional nerve block on stress response, inflammatory response and analgesic effect in patients with malignant gastrointestinal tumors after laparoscopic operation.Methods]Ninety patients with malignant gastrointestinal tumors were randomly divided into A, B and C groups, 30 cases in each group.The Group A was treated with intravenous anesthesia, the Group B received general anesthesia combined with epidural anesthesia, and the Group C underwent general anesthesia combined with transversus abdominis plane block.Comparison of three groups were made on anesthesia, skin incision of three groups (T0), 5min after skin incision (T1) and the mean arterial pressure (MAP) at the end of operation (T2), heart rate (HR), intra/postoperative cortisol (Cor) and inflammatory factors (IL-6, tumor necrosis factors) levels, postoperative pain and complications.Results]The hospitalization time and lying in bed time of the three groups were the Group C>the Group B and the Group A (P<0.05);the increase of MAP and HR in T0~T2 time range was smaller than that in group A (P<0.05);after operation ,the Cor, IL-6, TNF-αof the Group C increased significantly compared with the Group B and the Group A (P<0.05);6h, 12h after operation, VAS were less than that of the Group A and the Group B (P<0.05);complication rate of the Group C was 3.33%, significantly lower than that in the Group A 23.33% and the Group B 20% (P<0.05).Conclusion] General anesthesia combined with regional nerve block can obviously reduce the stress response, inflammatory response, pain with less dosage of anesthetics in patients with malignant gastrointestinal tumors.