超声引导下腹横肌平面阻滞联合腰-硬麻醉对下腹部手术患者术后疼痛及CRP、IL-6水平影响

摘要

[目的]探讨超声引导下腹横肌平面阻滞联合腰-硬麻醉对下腹部手术患者术后疼痛及C反应蛋白(CRP)、白细胞介素6(IL-6)水平的影响.[方法]选取2016年1月至2017年8月本院收治的下腹部手术患者80例作为研究对象,ASA分级为Ⅰ~Ⅱ级,均行腰-硬麻醉,随机分为对照组及观察组两组各40例.对照组接受经静脉患者自控镇痛(PCIA),观察组接受超声引导下腹横肌平面阻滞+PCIA.比较两组患者术后不同时刻的视觉模拟评分(VAS),Ramsay镇静评分,CRP、IL-6水平等指标.[结果]观察组术后2h、6h、24h时VAS评分均明显低于对照组,差异均有统计学意义(P<0.05),两组患者术后48h时VAS评分比较差异无统计学意义(P>0.05);两组患者术后不同时刻Ramsay镇静评分比较差异无统计学意义(P>0.05);观察组术后6h、24h、48h血清CRP、IL-6水平均明显低于对照组,差异均有统计学意义(P<0.05);观察组术后24h镇痛泵按压次数、舒芬太尼用量均明显低于对照组,差异均有统计学意义(P<0.05).[结论]超声引导下行腹横肌平面阻滞提高了腰-硬麻醉下腹部手术患者术后24h镇痛效果,减轻了炎症应激反应,值得临床推广应用.%[Objective]ToanaLyzetheeffectofuLtrasound-guidedtransversusabdominispLanebLockcombinedwith spinaLepiduraLanesthesiaonpostoperativeanaLgesia,serumCRPandIL-6LeveLsinpatientsundergoingLowerabdominaL surgery.[Methods]AtotaLof80patientswithLowerabdominaLsurgerywhoweretreatedinourhospitaLfromJanuary 2016toAugust2017wereseLectedastheresearchobjects.ALLpatients(ASAⅠorⅡgrade)underwentspinaLepiduraLanes-thesia.AccordingtorandomnumbertabLemethod,patientsweredividedintotwogroupswith40casesineach(n=40):theconventionaLgroupreceivedpatient-controLLedintravenousanaLgesia(PCIA)andthestudygroupreceiveduLtrasound guidedtransversusabdominispLanebLock+PCIA.TheVAS,Ramsaysedationscores,serum Creactiveprotein(CRP) andinterLeukin-6 (IL-6)LeveLsweremeasuredatdifferenttimesafteroperationandcomparedbetweenthetwogroups.[ResuLts]TheVASscoresatthe2,6and24hafteroperationinthestudygroupweresignificantLyLowerthanthoseinthe conventionaLgroup,thedifferenceswerestatisticaLLysignificant(P<0.05).TherewasnosignificantdifferenceinVAS scorebetweenthetwogroupsat48hafteroperation(P>0.05).TherewerenosignificantdifferencesinRamsayseda-tionscorebetweenthetwogroupsatdifferenttimepointsafteroperation(P>0.05).TheserumLeveLsofCRPandIL-6inthestudygroupweresignificantLyLowerthanthoseintheconventionaLgroupat6,24and48hafteroperation.The differenceswerestatisticaLLysignificant(P<0.05).ThenumberofpressingpumpandsufentaniLinthestudygroup24h afteroperationweresignificantLyLowerthanthoseintheconventionaLgroup,andthedifferenceswerestatisticaLLysignifi-cant(P<0.05).[ConcLusion]ULtrasound-guidedtransversusabdominispLanebLockimprovestheanaLgesiceffectandaL-LeviatesinfLammatorystressresponse24hourspost-operationinpatientswithLowerabdominaLsurgery.