摘要
目的探讨老年腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者采用全身麻醉联合腹横肌平面阻滞的应激反应、炎性反应及术后恢复情况。方法选取浙江省诸暨市人民医院于2017年1月至2020年1月收治的拟接受LC的老年患者70例为研究对象,采用随机数字表法分为联合组与常规组,每组各35例。常规组采用气管插管全身麻醉,联合组患者采用气管插管全身麻醉联合腹横肌平面阻滞。记录两组患者进入手术室后(T_(0))、气管插管后(T_(1))、气腹(T_(2))、术毕(T_(3))时刻的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(blood oxygen saturation,SpO_(2));记录两组患者手术前后的血清C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)、β-内啡肽(β-endorphin,β-EP)、白介素-2(interleukin-2,IL-2)水平,麻醉维持药物用量、苏醒时间、术后疼痛程度和不良反应发生情况。结果T_(1)时刻,联合组患者的MAP显著高于常规组(P<0.05),两组患者的HR、SpO_(2)比较差异均无显著性(P>0.05);T_(2)时刻,联合组患者的MAP、HR显著高于常规组(P<0.05),两组患者的SpO_(2)比较差异无显著性(P>0.05);T_(3)时刻,联合组患者的HR显著低于常规组(P<0.05),两组患者的MAP、SpO_(2)比较差异均无显著性(P>0.05)。联合组患者的丙泊酚和瑞芬太尼用量、苏醒时间均显著低于常规组(P<0.05)。术后24h,联合组患者的血清CRP、IL-6水平显著低于常规组(P<0.05)。术后4h、12h,联合组患者的视觉模拟评分法评分均显著低于常规组(P<0.05)。联合组患者不良反应发生率显著低于常规组(P<0.05)。结论老年LC患者采用全身麻醉联合腹横肌平面阻滞有利于维持患者血流动力学稳定,减轻手术引起的应激反应和炎性反应,减少麻醉药物用量和术后疼痛,且不良反应发生率更低。
Objective To explore the patients’stress,inflammatory response and postoperative recovery of general anesthesia combined with transverse abdominis plane block(TAPB)in elderly laparoscopic cholecystectomy(LC).Method A total of 70 elderly patients who were to undergo LC surgery from January 2017 to January 2020 in Zhuji People’s Hospital of Zhejiang Province were selected,and they were divided into combined group and routine group using a random number table method,with 35 cases in each group.The routine group patients received general anesthesia with endotracheal intubation,and the patients in the combined group received general anesthesia with endotracheal intubation combined with TAPB.The mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO_(2))were compared and analyzed,and the serum C-reactive protein(CRP),interleukin-6(IL-6),β-endorphin(β-EP),interleukin-2(IL-2),the amount of related anesthetics,recovery time and degree of postoperative pain and occurrence of adverse reactions were recorded.Result At T_(1),the MAP of the combined group was significantly higher than that of the routine group(P<0.05),and the levels of HR and SpO_(2) of the two groups were not significant(P>0.05);At T_(2),the MAP and HR of the combined group were significantly higher than those of the routine group(P<0.05),and there was no significance in SpO_(2) between the two groups(P>0.05);at T_(3),the HR of the combined group was significantly lower than that of the routine group(P<0.05),there was no significance in MAP and SpO_(2) between the two groups(P>0.05).The dosage of propofol,remifentanil,and recovery time in the combined group were significantly lower than those in the routine group(P<0.05).24h after operation,the levels of serum CRP and IL-6 in the combined group were significantly lower than the routine group(P<0.05).At 4h and 12h after operation,the visual analog scales scores of the combined group were significantly lower than routine group(P<0.05).The incidence of adverse reactions in the combined group was significantly lower than those in the routine group(P<0.05).Conclusion General anesthesia combined with TAPB for elderly patients with LC surgery is beneficial to maintain the stability of the patient’s blood flow,and reduce the stress reaction and inflammatory reaction caused by operation,and reduce the amount of anesthetic drugs and postoperative pain,and the incidence of adverse reactions is lower.
作者
葛科梁
赵锋
杨可
Ge Keliang;Zhao Feng;Yang Ke(Department of Anesthesiology,Zhuji People’s Hospital,Zhejiang Zhuji 311800,China)
出处
《中国医刊》
CAS
2021年第9期1006-1010,共5页
Chinese Journal of Medicine
基金
浙江省医学会临床科研基金项目(2026ZYC-A92)。
关键词
老年
腹腔镜胆囊切除术
全身麻醉
腹横肌平面阻滞
Elderly
Laparoscopic cholecystectomy
General anesthesia
Transverse abdominal muscle plane block
