【作者】 王雨晨；

【导师】 刘铜军；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2024， 硕士

【摘要】 目的:通过研究腹腔镜辅助腹横肌平面阻滞用于腹腔镜下结直肠癌手术患者对术后康复的影响,在腹腔镜结直肠癌手术中提供以外科医生为主导的腹横肌平面阻滞方法,增加腹横肌平面阻滞成功率,减轻患者术后疼痛,加速结直肠手术患者术后康复。方法:选择吉林大学白求恩第二医院接受全身麻醉腹腔镜下结直肠癌根治术患者63例,随机分为对照组(C组)共31例,和试验组即腹横肌平面阻滞组(R组)共32例。R组患者于全麻诱导气管插管、在五枚戳卡进入腹腔后,由外科医生操作,在直视下行双侧腹横肌平面阻滞,两侧各注射0.375%罗哌卡因20ml,C组患者为空白对照组即全麻诱导气管插管,插入五枚戳卡后,行腹腔镜下结直肠癌根治术。所有患者手术结束后均使用静脉自控镇痛泵(PCIA)。观察指标为患者进入苏醒室(T1),术后12小时(T2),术后24小时(T3),术后48小时(T4)的疼痛视觉模拟评分;术后镇痛泵首次按压时间,术后镇痛泵有效按压次数,术后24小时静脉血的白介素-6(IL-6),C反应蛋白(CRP);患者术后首次排气或排便时间;记录术后患者发生恶心呕吐等不良事件发生。结果:1.两组患者的年龄、ASA评分、手术时长呈非正态分布,BMI指数呈正态分布,两组患者一般情况无明显统计学差异(P>0.05)2.术后患者疼痛视觉模拟评分(VAS)的比较:两组患者T1-T4评分均呈正态分布,试验组患者T1-T3评分均低于对照组,且有统计学差异(P<0.05);试验组与对照组患者T4时VAS评分无显著统计学差异(P>0.05)。试验组患者T1-T4VAS评分均值逐步递增,T1与T2VAS评分无统计学差异(P>0.05),T2与T3、T3与T4VAS评分有统计学差异(P<0.05)。3.试验组(R组)和对照组(C组)镇痛泵首次按压时间、有效按压次数、镇痛补救次数均不符合正态分布,且差异有统计学意义(P<0.05)。4.术后24小时(T3)两组患者静脉血中白介素-6(IL-6)、C反应蛋白(CRP)浓度不符合正态分布,其中两组患者血液中IL-6浓度差异具有统计学意义(P<0.05);CRP浓度不具有统计学差异(P>0.05)。5.两组患者术后首次排气或排便时间符合正态分布,出监护室后首次离床活动时间不符合正态分布6.两组患者术后首次排气或排便时间、出监护室后首次离床活动时间无统计学差异(P>0.05)。7.试验组患者术后患者发生恶心呕吐情况少于对照组,其差异有统计学意义(P<0.05),所有患者均未发生肠瘘、腹腔内感染及肢体麻木活动障碍等不良事件。结论:1.腹腔镜下腹横肌平面阻滞联合静脉自控镇痛泵(PCIA)使用,能够显著降低患者术后疼痛评分,但对48小时后的疼痛评分无明显影响。2.腹腔镜下辅助腹横肌平面阻滞,可明显抑制患者术后IL-6水平,减轻炎症应激反应,对CRP指标无明显影响。3.腹腔镜辅助腹横肌平面阻滞对患者首次排气或排便时间、出监护室后首次离床活动时间均无明显影响。4.腹腔镜下腹横肌平面阻滞患者术后发生恶心呕吐的情况更少。更多还原

【Abstract】 Objective: To provide a surgeon-driven approach to transversus abdominis plane block in laparoscopic colorectal cancer surgery by investigating the effect of laparoscopic-assisted transversus abdominis plane block used in patients undergoing laparoscopic colorectal cancer surgery on postoperative recovery,to increase the success rate of transversus abdominis plane block,to reduce patients’ postoperative pain,and to accelerate postoperative recovery of patients undergoing colorectal surgery.Methods: Sixty-three patients undergoing laparoscopic radical colorectal cancer surgery under general anesthesia in Baiqiu’en Second Hospital of Jilin University were selected and randomly divided into 31 cases in the control group(Group C)and 32 cases in the experimental group,i.e.,the transversus abdominis plane block group(Group R).Patients in the Group R were induced to be intubated by trachea under general anesthesia,and after the entry of five poke cards into the abdominal cavity,they were operated by the surgeon,and the transversus abdominis plane block was carried out bilaterally under the direct vision,and each side was injected with 0.375% ropivacaine 20 ml,patients in group C were blank control group i.e.,general anesthesia induced tracheal intubation,after insertion of five poke cards,laparoscopic radical surgery for colorectal cancer was performed.Intravenous self-control analgesic pump(PCIA)was used in all patients at the end of surgery.The observational indexes were the visual analog score of pain when the patients entered the awakening room(T1),12 hours after the operation(T2),24 hours after the operation(T3),and 48 hours after the operation(T4);the time of the first press of the analgesic pump after the operation,the number of effective presses of the analgesic pump after the operation,the interleukin-6(IL-6)of the venous blood at 24 hours after the operation,and C-reactive protein(CRP);and the time when the patients had their first postoperative bowel movement or defecation;The occurrence of adverse events such as nausea and vomiting in postoperative patients was recorded.Results:1.The age,ASA score,and length of surgery of the two groups were non-normally distributed,and the BMI index was normally distributed,and there was no statistically significant difference in the general conditions of the two groups(P>0.05)2.Comparison of postoperative patients’ pain visual analog scores(VAS): the T1-T4 scores of patients in both groups were normally distributed,and the T1-T3 scores of patients in the experimental group were lower than those of the control group,and there was a statistically significant difference(P<0.05);there was no statistically significant difference in the VAS scores of patients in the experimental group and the control group at the time of T4(P>0.05).The mean values of T1-T4 VAS scores of patients in the test group increased gradually,and there was no statistically significant difference between T1 and T2 VAS scores(P>0.05),and statistically significant difference between T2 and T3,and T3 and T4 VAS scores(P<0.05).3.The time to the first press of the analgesic pump,the number of effective presses,and the number of analgesic remedies in the test group(Group R)and the control group(Group C)did not conform to normal distribution,and the difference was statistically significant(P<0.05).4.The concentrations of interleukin-6(IL-6)and C-reactive protein(CRP)in the venous blood of patients in the two groups at 24 hours after surgery(T3)did not conform to normal distribution,in which the difference between the concentrations of IL-6 in the blood of patients in the two groups was statistically significant(P<0.05);the concentration of CRP did not have a statistical difference(P>0.05).5.the time of the first postoperative defecation or bowel movement of the two groups of patients conformed to normal distribution,and the time of the first time to leave the bed after leaving the monitoring room did not conform to normal distribution.6.There is no statistical difference between the two groups in terms of the time of the first postoperative gas or bowel movement and the time of the first time out of bed after leaving the monitoring room(P>0.05).7.the postoperative nausea and vomiting of patients in the experimental group was less than that in the control group,and the difference was statistically significant(P<0.05),and none of the patients had adverse events such as enterocutaneous fistulae,intra-abdominal infections,and numbness of limbs with impaired mobility.Conclusion: 1.Laparoscopic transversus abdominis plane block combined with the use of intravenous selfcontrolled analgesic pump(PCIA)was able to significantly reduce the patients’ postoperative pain scores,but had no significant effect on pain scores after 48 hours.2.Laparoscopic-assisted transversus abdominis plane block can significantly inhibit patients’ postoperative IL-6 levels and reduce inflammatory stress response,with no significant effect on CRP index.3.Laparoscopic assisted transversus abdominis plane block had no significant effect on the time of the first gas or bowel movement and the time of the first time to leave the bed after leaving the monitoring room.4.Patients with laparoscopic transversus abdominis plane block had fewer cases of postoperative nausea and vomiting.更多还原