Abstract:

Objective　To evaluate the effect applying ultrasound-guided transverse abdominis plane block (TAP) and hydromorphone in fast-track surgery (FTS) after laparoscopic radical resection for elderly patients with colon cancer. Methods　Two hundred and two elderly patients with colon cancer who underwent laparoscopic radical resection at Hospital of 73rd Group Army from April 2020 to April 2023 were selected for the randomized controlled trial, including 122 males and 80 females who were 65-85 years old. The patients were divided into a TAP group (67 cases), a TAP+H group (68 cases), and an H group (67 cases) by the random number table method. The TAP group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP; the TAP+H group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP and hydromorphone by intravenous analgesia pumps; the H group were given hydromorphone by intravenous analgesia pumps. The heart rates (HR), mean artery pressures (MAP), pain scores of Visual Analogue Scale (VAS), and numbers of injections of intravenous salvage analgesics 1, 8, and 48 h after the surgery and incidences of adverse reactions were compared between the 3 groups. t test and rank sum test were used. Results　One and eight hours after the surgery, the HR's and MAP's in the H group were higher than those in the TAP+H group [(83.93± 5.61) times/min vs. (80.62± 7.10) times/min, (88.28±4.79) mmHg (1 mmHg=0.133 kPa) vs. (81.97+5.12) mmHg, and (84.78±4.08) times/min vs. (81.18±3.90) times/min, and (91.54±5.33) mmHg vs. (82.32±5.60) mmHg], with statistical differences (t=2.01, 2.38, 2.15, and 2.04; all P<0.05). Eight and forty-eight hours after the surgery, the HR's and MAP's in the TAP group were higher than those in the TAP+H group [(85.84± 5.21) times/min vs. (81.18± 3.90) times/min, (85.61±4.91) mmHg vs. (82.32±5.60) mmHg, (87.32± 4.51) times/min vs. (86.10± 3.40) times/min, and (93.51±6.17) mmHg vs.(90.22±4.85) mmHg], with statistical differences (t=2.36, 2.83, 2.00, and 2.21; all P<0.05). Within 48 h after the surgery, the incidences of nausea and vomiting and the incidences of headache and dizziness in the TAP group (19.4% and 1.5%) and the TAP+H group (25.0% and 4.4%) were relatively lower. Conclusions　The application of ultrasound-guided transverse abdominis plane block combined with hydromorphone in fast-track surgery of elderly patients taking laparoscopic radical resection for colon cancer is effective. It enhances the analgesic effect, reduces the elderly patients' postoperative physical stress response and adverse reactions, promotes their independent eating, and achieves fast recovery.

Key words:

Colon cancer, Laparoscopic surgery, Hydromorphone, Transverse abdominis plane block, Fast-track surgery

摘要：

目的　评价超声引导下腹横肌平面（TAP）阻滞联合氢吗啡酮在老年患者腹腔镜结肠癌根治术后快速康复外科（FTS）理念中的应用效果。方法　选取2020年4月至2023年4月在陆军第七十三集团军医院行腹腔镜结肠癌根治术的老年患者202例进行随机对照试验，男性122例、女性80例，年龄65～85岁，按随机数字表法将患者分为3组：TAP组（67例）、TAP+H组（68例）与H组（67例）。TAP组采用超声引导下TAP给予0.25%的罗哌卡因20 ml阻滞，TAP+H组采用超声引导下TAP给予0.25%的罗哌卡因20 ml阻滞联合氢吗啡酮静脉镇痛泵，H组单纯给氢吗啡酮静脉镇痛泵。对比3组患者在术后1 h、8 h与48 h的心率（HR）、平均动脉压（MAP）、视觉模拟评分法（VAS）疼痛评分、静脉补救性镇痛剂的注射次数与不良反应情况。统计学方法采用t检验、秩和检验等。结果　术后1 h与8 h，H组HR与MAP均高于TAP+H组［（83.93± 5.61）次/min比（80.62± 7.10）次/min、（88.28±4.79）mmHg（1 mmHg=0.133 kPa）比（81.97+5.12）mmHg、（84.78±4.08）次/min比（81.18±3.90）次/min、（91.54±5.33）mmHg比（82.32 ±5.60）mmHg］，差异均有统计学意义（t=2.01、2.38、2.15、2.04，均P<0.05）；术后8 h与48 h，TAP组HR与MAP均高于TAP+H组［（85.84± 5.21）次/min比（81.18± 3.90）次/min、（85.61±4.91）mmHg比（82.32±5.60）mmHg、（87.32± 4.51）次/min比（86.10± 3.40）次/min、（93.51±6.17）mmHg比（90.22±4.85）mmHg］，差异均有统计学意义（t=2.36、2.83、2.00、2.21，均P<0.05）。3组患者在术后48 h内，均有注射静脉补救性镇痛药，其中以H组注射次数最多。在术后48 h内，TAP组恶心呕吐、头疼头晕（19.4%、1.5%）较TAP+H组（25.0%、4.4%）低。结论　超声引导下TAP阻滞联合氢吗啡酮在老年患者腹腔镜结肠癌根治术后FTS理念中是有效的，该麻醉方式能增强镇痛效果，降低老年患者术后身体应激反应，减少不良反应发生情况，促进患者自主进食，实现快速康复。

关键词:

结肠癌, 腹腔镜手术, 氢吗啡酮, 腹横肌平面阻滞, 快速康复外科理念