关键词: 腹横肌平面阻滞, 腹腔镜袖状胃切除术, 应激反应, 疼痛抑制, 超声引导

Abstract: Objective To investigate the effect of ultrasound-guided transverse abdominal plane block (TAPB) on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods 98 cases of laparoscopic sleeve Gastrectomy patients admitted from March 2021 to October 2022 were selected as the research object,and they were randomly divided into control group (49 cases) and observation group (49 cases) by double blind method.The control group received general anesthesia,and the observation group received TAPB+general anesthesia.The postoperative pain,analgesic dosage,stress level,hemodynamics and adverse reactions of the two groups were compared. Results The dosage of sufentanil and propofol in the observation group,as well as the effective press frequency of the intravenous analgesia pump 48 hours after surgery[(232.38±29.62)μg ,(328.40±40.68) mg and (5.60±1.25)],were lower than those in the control group[(294.07±35.88)μg,(402.25±46.74)mg and(9.75±2.40)](P<0.05).The visual analogue scale (VAS) scores for each time period of the observation group were (2.43±0.49),(2.29±0.46),(2.85±0.49),(2.41±0.39),(2.12±0.41) and(1.82±0.32),respectivly.While,the control group were (2.95±0.46),(3.22±0.51),(3.92±0.47),(3.13±0.65),(2.83±0.57) and(2.05±0.53),respectivly.The difference between the two groups was statistically significant(P<0.05).At the time of tracheal intubation (T₂),at the end of operation (T₃),and at the time of leaving the anesthesia recovery room (T₄),the fluctuation range of mean arterial pressure[86 .00(79.00,94.00)mmHg,87.00(80.00,90.00)mmHg and 89.00(84.00,95.00)mmHg vs 82.00(75.00,90.00)mmHg,85.00(77.00,93.00)mmHg and 87.00(80.00,97.00)mmHg],heart rate[78.00(67.00,83.00）times/min,80 .00(74.00,86.00）times/min and 81.00(76.00,90.00)times/min vs 78.00(67.00,83.00)times/min,80.00 (74.00,86.00)times/min and 81.00(76.00,90.00)times/min] and blood oxygen saturation[97.38(97.00,97.75)%,98.69(98.30,99.05)% and 99.16(98.80,99.35)% vs 96.54(96.15,96.80)%,98.02(97.65,98.45)% and 98.73(98.43,99.15)%] in the observation group was significantly smaller than that of the control group (P<0.05).In the observation group, cortisol levels were (192.47±40.25)ng/ml, (151.34±39.62)ng/ml and (118.69±30.57)ng/ml at 6 hours, 24 hours and 48 hours, respectively,while in the control group were (206.24±45.34)ng/ml,(178.24±37.58)ng/ml and (143 .63±32.34)ng/ml,respectively;C-reactive protein (CRP) in the observation group were (25.24±6.29)mg/L,(20.93±5.83)mg/L and (13.61±4.29)mg/L, respectively,while in the control group were (28.13±6.92)mg/L,(23.25±5.21)mg/L and (16.38±4.35)mg/L, respectively;interleukin-6 (IL-6) in the observation group were (44.87±7 .95)pg/L,(38.34±6.13)pg/L and (34.27±5.32)pg/L,respectively,while in the control group were (56.43±7.23)pg/L、(42.24±6.58)pg/L、(37.66±6.03)pg/L,respectively.The difference between the two groups was statistically significant(P<0.05).The total incidence of adverse reactions of the observation group(4.08%) was lower in than that of the control group(20.41%) (P<0.05). Conclusion Ultrasound-guided TAPB for LSG patients has a good effect on postoperative pain suppression,can reduce the stress response of the body after surgery,and is safe.

Key words: plane block of transverse abdominal muscle, laparoscopic sleeve gastrectomy, stress response, pain inhibition, ultrasound-guided