摘要
目的探讨结直肠癌(colorectal cancer,CRC)手术患者运用超声引导下腹横筋膜阻滞(transthoracic fascial anesthesia,TAPB)复合气管插管全身麻醉的效果,为临床合理有效的麻醉方案制定提供参考。方法回顾性分析2018年12月—2021年12月于商丘市第一人民医院行腹腔镜结直肠手术的115例CRC患者临床资料。根据术中麻醉方式的不同分为对照组(气管插管全身麻醉,58例)与观察组(超声引导下TAPB复合气管插管全身麻醉,57例)。比较两组血流动力学[平均动脉压(MAP)、心率(HR)]、术后疼痛[视觉模拟评分法(VAS)评估]及术后48 h内并发症情况。结果基于广义估计方程分析,结果显示,T_(1)时两组MAP、HR值比较,差异无统计学意义(P>0.05);T_(2)、T_(3)时,两组MAP、HR值较T_(1)时均升高,且观察组T_(2)、T_(3)时MAP、HR值小于对照组,差异有统计学意义(P<0.05);经广义估计方程分析,结果显示,较术后2 h,两组术后4 h、8 h的VAS评分均降低,术后12 h的VAS评分均升高,且观察组术后2 h、4 h、8 h的VAS评分均低于对照组(P<0.05);但两组术后12 h的VAS评分比较,差异无统计学意义(P>0.05);术后48 h内,观察组并发症发生率低于对照组(P<0.05)。结论超声引导下TAPB复合气管插管全身麻醉可有效维持CRC手术患者血流动力学稳定,降低术后疼痛及减少术后并发症。
Objective To explore the clinical effect of ultrasound-guided transthoracic fascial anesthesia(TAPB)in patients with colorectal cancer(CRC)surgery.Methods The clinical data of 115 patients with CRC surgery who underwent laparoscopic colorectal surgery in Shangqiu the First People’s Hospital during the study period(from December 2018 to December 2021)were analyzed retrospectively.According to different anesthesia methods during operation,they were divided into control group(58 cases of general anesthesia with endotracheal intubation)and observation group(57 cases of general anesthesia with utrasound-guided TAPB combined with endotracheal intubation).Hemodynamics[mean arterial pressure(MAP),heart rate(HR)],postoperative pain[assessed by visual analogue scale(VAS)]and complications within 48 hours were compared between the two groups.Results The results based on the analysis of generalized estimation equation showed that,compared MAP and HR values between the two groups at T_(1),there was no statistical significant difference(P>0.05);at T_(2) and T_(3),the MAP and HR values of both groups were increased than those at T_(1),and the MAP and HR values of the observation group at T_(2) and T_(3) were lower than those of the control group,with statistical significant differences(P<0.05);Through the analysis of generalized estimation equation,the results showed that,compared with 2 h after operation,the VAS scores 4 h and 8 h after operation in both groups were decreased,and the VAS scores 12 h after operation in the observation group were increased,and the VAS scores 2 h,4 h and 8 h after operation in the observation group were lower than those in the control group(P<0.05);However,compared VAS score between the two groups 12 hours after operation,there was no statistical significant difference(P>0.05);Within 48 hours after operation,the incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion Ultrasound-guided TAPB combined with general anesthesia with endotracheal intubation can effectively maintain the hemodynamic stability of patients with CRC surgery,reduce postoperative pain and reduce postoperative complications.
作者
刘京广
LIU Jing-guang(Department of Anesthesiology,Shangqiu the First People's Hospital,Shangqiu,Henan 476100,China)
出处
《医药论坛杂志》
2022年第18期22-26,31,共6页
Journal of Medical Forum
关键词
结直肠癌
气管插管全身麻醉
超声引导下腹横筋膜阻滞
血流动力学
Colorectal cancer
general anesthesia with endotracheal intubation
Ultrasound-guided transversus abdominis plane block
Hemodynamics
