目的 比较腹横筋膜阻滞复合腹直肌鞘阻滞(TFP-RSB)与腹横筋膜平面阻滞(TFP)对糖尿病患者行妇科腹腔镜全子宫切除术后的镇痛功效及对患者炎性反应的影响.方法 选取山西医科大学第二医院2021年12月至2022年9月行妇科腹腔镜全子宫切除术的2型糖尿病患者90例,将患者分为TFP-RSB组(n=30)、TFP组(n=30)和空白对照组(n=30),TFP-RSB组术后镇痛采用超声引导下的TFP-RSB,TFP组采用TFP,药物选用0.375％的罗哌卡因,TFP-RSB组和TFP组均联合静脉自控镇痛泵(PCIA)复合镇痛.空白对照组仅术后使用PCIA,比较3组患者围手术期镇痛效果、术后睡眠质量及术后6、12、24 h VAS评分,于术前及术后6、12、24 h检测IL-6、Apelin-13,术后6、12、24 h进行血糖测定.结果 TFP-RSB组和TFP组术后6、12、24 h血糖均低于空白对照组(P＜0.05);TFP-RSB组术后各时间段血糖均低于TFP组(P＜0.05);3组术中镇静药物丙泊酚和镇痛药物瑞芬太尼用量差异无统计学意义(P＞0.05);TFP-RSB组术后12、24 h VAS评分低于TFP组(P＜0.05),但术后6 h VAS评分两组间差异无统计学意义(P＞0.05);TFP-RSB和TFP组术后6、12、24 h VAS评分均低于空白对照组(P＜0.05);术后24 h舒芬太尼消耗量TFP-RSB组少于TFP组(P＜0.05);TFP-RSB组匹兹堡睡眠质量指数(PQS)优于TFP组与空白对照组(P＜0.05);TFP-RSB组IL-6水平低于TFP组和空白对照组(P＜0.05),TFP组和空白对照组术后24 h IL-6水平差异无统计学意义(P＞0.05);3组术前Apelin-13水平低于术后各时间段(P＜0.05);术后6、12、24 h TFP-RSB组血清Apelin-13水平低于TFP组(P＜0.05),同时TFP-RSB组与TFP组均低于空白对照组(P＜0.05);术后恶心呕吐率TFP组(26.6％)低于空白对照组(50.0％),但差异无统计学意义(P＞0.05);TFP-RSB组(3.3％)低于TFP组(26.6％)和空白对照组(50.0％),差异有统计学意义(P＜0.05).结论 相较于TFP阻滞,TFP-RSB对于行妇科腹腔镜全子宫切除术的糖尿病患者来说术后镇痛效果更好、血糖波动更小、抑制炎性反应效果更明显.
Effect of TFP-RSB and TFP on inflammatory stress and postoperative analgesia in patients undergoing laparoscopic total hysterectomy with diabetes
Objective To compare the efficacy of transversus fascia plane block combined with rectus sheath block(TFP-RSB)and transversus fascia plane block(TFP)in alleviating postoperative pain and in-flammation in patients with type 2 diabetes undergoing gynecologic laparoscopic total hysterectomy.Methods A total of 90 patients with type 2 diabetes who underwent gynecologic laparoscopic total hysterecto-my in the Second Hospital of Shanxi Medical University from December 2021 to September 2022 were ran-domly divided into the TFP-RSB group(n=30),the TFP group(n=30),and the blank control group(n=30).The TFP-RSB group received ultrasound-guided TFP-RSB for postoperative analgesia,and the TFP group received TFP block after surgery.The drug was 0.375％ropivacaine.Both groups received combined with pa-tient-controlled intravenous analgesia(PCIA)and those in the control group were treated with PCIA only.The efficacy of perioperative analgesia,postoperative sleep quality and Visual Analog Scale(VAS)scores at 6 h,12 h,and 24 h after operation were compared among the three groups.The levels of IL-6 and Apelin-13 were measured before surgery and at 6 h,12 h,and 24 h postoperatively,and blood glucose was measured at 6 h,12 h,and 24 h postoperatively.Results The blood glucose levels at 6 h,12 h,and 24 h after operation in the TFP-RSB and the TFP groups were lower than those in the blank control group(P＜0.05).The blood glucose in the TFP-RSB group was lower than that in the TFP group at each time point after operation(P＜0.05).There was no statistical difference in the dosage of sedatives and analgesics used during surgery between the TFP-RSB group and the TFP group(P＞0.05).VAS scores at 12 h and 24 h postoperatively were generally lower in the TFP-RSB group compared to the TFP group(P＜0.05),as well as compared to the blank control group(P＜0.05).There was no significant difference in VAS scores at 6h postoperatively between the TFP-RSB and TFP groups(P＞0.05),but both were lower than the blank control group(P＜0.05).The con-sumption of sufentanil at 24 h postoperatively was slightly lower in the TFP-RSB group than in the TFP group(P＜0.05).The PQSI sleep quality in the TFP-RSB group was better than that in the TFP and the blank control groups(P＜0.05).The levels of inflammatory factor IL-6(at 6 h,12 h,and 24 h postoperative-ly)were generally lower in the TFP-RSB group compared to the TFP group and the blank control group(P＜0.05),with no significant difference between the TFP group and the blank control group at 24 h postopera-tively(P＞0.05).Apelin-13 levels were lower at all postoperative time points compared to preoperative levels in all three groups(P＜0.05).Serum Apelin-13 levels at 6 h,12 h,and 24 h postoperatively were lower in the TFP-RSB group than in the TFP group(P＜0.05),and both were lower than the blank control group(P＜0.05).The incidence of postoperative nausea and vomiting was lower in the TFP group(26.6％)than in the blank control group(50.0％),but the difference was not statistically significant(P＞0.05).The incidence in the TFP-RSB group(3.3％)was lower than in the TFP group(26.6％)and the blank control group(50.0％),P＜0.05.Conclusion Compared with TFP block,TFP-RSB block has better postoperative analge-sia effect,less blood glucose fluctuations,and more obvious inhibitory effect on inflammatory response in dia-betic patients undergoing gynecological laparoscopic total hysterectomy.
diabetesgynecological laparoscopynerve blocktransverse fascia planerectus abdominis sheathanalgesia
万方数据
维普
