摘要
[目的]探讨超声引导下连续竖脊肌平面阻滞(ESP)在中低位直肠癌术后疼痛及术后免疫功能的影响.[方法]选择接受治疗的中低位直肠癌患者78例为研究对象,按照是否采用超声引导下ESP麻醉治疗,分为观察组(n=46)和对照组(n=32).比较2组患者术前与术后免疫功能相关指标(淋巴细胞亚群)水平;对比分析2组患者术后2、4、6、12、24、48 h的视觉模拟评分(VAS)及镇静(Ramsay)评分.记录实验室指标及不良症状发生情况.[结果]VAS评分方面,除术后24、48 h外,其余时间两组比较差异均有统计学意义(P＜0.05);Ramsay评分方面,除术后6、24、48 h外,其余时间2组比较差异均有统计学意义(P＜0.05).2组免疫细胞水平比较,术后24、48 h,观察组CD4+水平高于对照组,差异有统计学意义(P＜0.05);术后2、48 h,观察组CD8+水平低于对照组,差异有统计学意义(P＜0.05);术后2、24、48 h,观察组CD4+/CD8+水平高于对照组,差异有统计学意义(P＜0.05);术后2、24、48 h,观察组CD4+CD25+水平低于对照组,差异有统计学意义(P＜0.05);其余时间比较均差异无统计学意义(P＞0.05).随机行走模型结果显示,同一指标相比,观察组VAS、Ramsay、CD4+、CD8+、CD4+/CD8+、CD4+CD25+较对照组行走步数较少,正向递增率较高.[结论]超声引导下连续ESP可有效降低中低位直肠癌患者的术后疼痛,导致CD4+、CD8+、CD4+/CD8+、CD4+CD25+指标水平变化.
Abstract
[Objective]To explore the effects of ultrasound-guided continuous erector spinal muscle plane block(ESP)on postoperative pain and postoperative immune function in middle and low rectal cancer..[Methods]Seventy-eight patients with middle and low rectal cancer who received treatment were selected as the study objects.According to whether the ultrasound-guided ESP anesthesia was used,they were divided into observation group(n=46)and control group(n=32).The levels of immune function-related indicators(lymphocyte subsets)before and after the two groups;the visual analogue scale(VAS)and sedation(Ram-say)score,were compared.Laboratory indicators and side effect occurrence were recorded.[Results]In terms of VAS score,except for 24 and 48 h after operation,the difference in the two groups were statisti-cally significant(P＜0.05);in terms of Ramsay score,except for 6,24,and 48 h after operation,the differ-ences in the other time in the two groups were statistically significant.(P＜0.05).Comparison of the levels of immune cells between the two groups,in terms of CD4+,24 and 48 hours after surgery,the observation group was higher than the control group at the same time,the difference was statistically significant(P＜0.05);in terms of CD8+,after 2,48 h,the level in the observation group was lower than that of the control group at the same time,and the difference was statistically significant(P＜0.05);in terms of CD4+/CD8+,the level of the observation group was higher than the control group at the same time at 2,24,and 48 hours after the operation,and the difference was statistically significant.(P＜0.05);in terms of CD4+CD25+,the level of the observation group was lower than that of the control group at the same time at 2,24,and 48 hours after surgery,the difference was statistically significant(P＜0.05);there was no statistical difference at other times(P＞0.05).The results of the random walking model showed the VAS,Ramsay,CD4+,CD8+,CD4+/CD8+,CD4+CD25+in observation group had fewer steps and a higher positive rate of in-crease than the control group.[Conclusion]The ultrasound-guided continuous plane block of erector spinal muscles can effectively reduce postoperative pain in patients with middle-low rectal cancer,resulting in changes in the index levels of CD4+,CD8+,CD4+/CD8+,and CD4+CD25+indicators.
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