腰方肌阻滞联合艾司氯胺酮全程应用对腹腔镜结肠癌术后效果分析
Analysis of the postoperative effects of quadratus lumborum block combined with continuous esketamine application during laparoscopic colon cancer surgery
陈冬冬 1李海锟 2王龙才 1闫书山3
作者信息
- 1. 山东第二医科大学附属医院麻醉科,山东潍坊 261031
- 2. 山东第二医科大学附属医院泌尿外科
- 3. 山东第二医科大学附属医院胃肠外科
- 折叠
摘要
目的 探讨腰方肌阻滞联合艾司氯胺酮全程应用对腹腔镜结肠癌根治术后的效果.方法 选取2023年1月～2023年12月拟择期行腹腔镜结肠癌根治术患者80例,随机分为对照组和干预组,每组40例.对照组采用超声引导腰方肌阻滞(QLB),常规全麻诱导、维持及术后使用镇痛泵,干预组在对照组基础上,分别于手术切皮前、术中麻醉维持时及术后应用镇痛泵的同时分别加用艾司氯胺酮.收集两组患者各时间点的NRS评分、T0(术前24 h)和T5(术后48 h)的QoR-40评分以及术前24 h和出院时的HADS评分.检测两组患者手术前后CD3+、CD4+、CD4+/CD8+和IL-6、IL-10水平,统计不良反应发生率.用统计学方法分析比较上述指标.结果 两组患者各时间点NRS评分无明显差异(P＞0.05);T5时干预组CD3+、CD4+、CD4+/CD8+水平明显高于对照组(P＜0.05);T4时干预组IL-6水平低于对照组(P＜0.05),不同时间点IL-10含量无明显差异(P＞0.05);干预组术后48h QoR-40评分明显升高,出院时HADS评分明显降低,术后不良反应率明显降低(P＜0.05).结论 QLB联合艾司氯胺酮围术期全程应用,可有效缓解腹腔镜结肠癌根治术后疼痛,明显降低术后不良反应,调节炎性因子释放,从而改善术后免疫功能,有效改善术后焦虑抑郁睡眠状态.
Abstract
Objective To investigate the effects of quadratus lumborum block combined with esketamine throughout the application on the postoperative outcomes of laparoscopic radical surgery for colon cancer.Methods A total of 80 patients scheduled for elective laparoscopic radical resection for colon cancer during January 2023 to Decem-ber 2023 were randomly assigned to a control group and an intervention group,with 40 patients in each group.The con-trol group received ultrasound-guided QLB,conventional general anesthesia induction,maintenance and postoperative an-algesia with a pain pump.The intervention group received esketamine in addition to the treatments provided to the control group,specifically before skin incision,during intraoperative anesthesia maintenance and concurrently with postoperative analgesia using a pain pump.The Numerical Rating Scale(NRS)scores at various time points,Quality of Recovery-40(QoR-40)scores at T0(24 hours preoperatively)and T5(48 hours postoperatively)and Hospital Anxiety and Depres-sion Scale(HADS)scores at 24 hours preoperatively and at discharge were collected for both groups.Preoperative and postoperative levels of CD3+,CD4+,CD4+/CD8+,interleukin-6 and interleukin-10 were measured and the incidence of adverse reactions was recorded.Statistical methods were employed to analyze and compare these parameters.Results There were no significant differences in NRS scores between the two groups at various time points(P＞0.05).At T5,the intervention group exhibited significantly higher levels of CD3+,CD4+and CD4+/CD8+compared to the control group(P＜0.05).At T4,the intervention group had lower levels of IL-6 than the control group(P＜0.05),with no significant differences in IL-10 levels at different time points(P＞0.05).The intervention group demonstrated a significant increase in QoR-40 scores at 48 hours postoperatively,marked reduction in HADS scores at discharge,and significantly lower inci-dence of postoperative adverse reactions(P＜0.05).Conclusion The perioperative application of QLB combined with continuous esketamine administration effectively alleviated postoperative pain following laparoscopic radical resection for colon cancer,significantly reduced postoperative adverse reactions,modulated the release of inflammatory factors,thus improving postoperative immune function and anxiety-depressive sleep states.
关键词
腰方肌阻滞/艾司氯胺酮/焦虑抑郁/免疫功能/炎性因子Key words
Quadratus Lumborum Block/Esketamine/Anxiety-Depression/Immune Function/Infla-mmatory Cytokines引用本文复制引用
出版年
2024
NETL
NSTL
万方数据