摘要
目的 探讨不同剂量布托啡诺联合腹横肌平面阻滞(TAP)在腹腔镜下结直肠癌根治术中的应用效果.方法 采用前瞻性研究,选取2021年5月至2024年5月西安市中医医院收治的择期行腹腔镜下结直肠癌根治术的96例患者作为研究对象.按照随机数字表法分为对照组、布托啡诺1组、布托啡诺2组,各组32例.所有患者均采取全身麻醉联合TAP术后镇痛,麻醉诱导前对照组患者给予5 mL 0.9％氯化钠溶液静脉注射,布托啡诺1组患者给予布托啡诺15 μg/kg,布托啡诺2组患者给予布托啡诺20 µg/kg,手术结束后3组患者均给予TAP.比较3组患者麻醉效果,入室后(T0)、切皮时(T1)、手术10 min后(T2)和手术结束即刻(T3)的生命体征波动[血氧饱和度(SpO2)、平均动脉压(MAP)、心率],手术后2、6、8、12 h的疼痛程度[视觉模拟评分法(VAS)],手术前、手术后1 d的炎症因子[C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)]水平及不良反应发生情况.结果 布托啡诺1组与布托啡诺2组麻醉优良率分别为96.88％、100.00％,明显高于对照组(81.25％),差异有统计学意义(P＜0.05).3组患者T0、T1、T2、T3时SpO2水平,T0、T3时MAP、心率水平无明显变化,3组比较差异均无统计学意义(P＞0.05);布托啡诺2组T1、T2时的MAP、心率均低于对照组、布托啡诺1组,差异均有统计学意义(P＜0.05).手术后2、6、8、12 h,布托啡诺2组患者VAS评分均明显低于布托啡诺1组与对照组,差异均有统计学意义(P＜0.05).手术后1 d,3组患者血清CRP、TNF-α水平均较手术前升高,IL-2水平均手术前降低,差异均有统计学意义(P＜0.05);手术后1 d,布托啡诺2组CRP、TNF-α、IL-2水平均明显低于对照组和布托啡诺1组,差异均有统计学意义(P＜0.05).3组患者总不良反应发生率比较,差异无统计学意义(P＞0.05).结论 针对腹腔镜下结直肠癌根治术在全身麻醉基础上增加布托啡诺联合TAP镇痛效果更优,且采用20 μg/kg布托啡诺剂量可进一步提升麻醉优良率,稳定术中生命体征,减轻术后炎症反应,且具有持续术后镇痛作用,安全性高.
Abstract
Objective To explore the application effect of different doses of butorphanol combined with transverse abdominis plane block(TAP)in laparoscopic radical resection for colorectal cancer.Methods A prospective study was conducted to select 96 patients who underwent laparoscopic radical resection of colorectal cancer in Xi'an Hospital of Traditional Chinese Medicine from May 2021 to May 2024 as the study sub-jects.According to the random number table method,they were divided into the control group,the butorphanol group 1 and the butorphanol group 2,with 32 cases in each group.All patients were given general anesthesia combined with TAP for postoperative analgesia.Before anesthesia induc-tion,the patients in the control group were given 5 mL 0.9％sodium chloride solution intravenously.The patients in the butorphanol group 1 were given 15 µg/kg butorphanol,and the patients in the butorphanol group 2 were given 20 μg/kg butorphanol.After the operation,the patients in the three groups were given TAP.The anesthetic effect,the fluctuation of vital signs[oxygen saturation(SpO2),mean arterial pressure(MAP),heart rate]after entering the room(T0),skin incision(T1),10 min after operation(T2)and immediately after operation(T3),the degree of pain[visual analogue scale(VAS)]at 2,6,8 and 12 h after operation,the levels of inflammatory factors[C-reactive protein(CRP),interleu-kin-2(IL-2),tumor necrosis factor-α(TNF-α)]before operation and 1 d after operation and the occurrence of adverse reactions were com-pared among the three groups.Results The excellent and good rates of anesthesia in butorphanol group 1 and butorphanol group 2 were 96.88％and 100.00％,respectively,which were significantly higher than those in the control group(81.25％),and the differences were statistically sig-nificant(P＜0.05).There was no significant difference in SpO2 level at T0,T1,T2 and T3,MAP and heart rate at T0 and T3 among the three groups(P＞0.05).The MAP and heart rate of butorphanol group 2 at T1,T2 were lower than those of control group and butorphanol group 1,the differences were statistically significant(P＜0.05).At 2,6,8 and 12 h after operation,the VAS scores of butorphanol group 2 were signifi-cantly lower than those of butorphanol group 1 and control group,and the differences were statistically significant(P＜0.05).At 1 day after op-eration,the levels of serum CRP and TNF-α in the three groups were higher than those before operation,and the levels of IL-2 were lower than those before operation,the differences were statistically significant(P＜0.05).At 1 day after operation,the levels of CRP,TNF-α,and IL-2 in butorphanol group 2 were significantly lower than those in control group and butorphanol group 1,the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of total adverse reactions among the three groups(P＞0.05).Conclusion For laparoscopic radical resection for colorectal cancer,adding butorphanol combined with TAP for analgesia on the basis of general anesthesia is more effective,and adopting a dose of 20 µg/kg of butorphanol can further improve the rate of anesthesia excellence,stabilize the intraoperative vi-tal signs,reduce the postoperative inflammatory reaction,and have a sustained postoperative analgesic effect,with a high degree of safety.
维普
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