Wang Ya-Ya, Fu Hua-Jun
Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
World J Gastrointest Surg. 2023 Oct 27;15(10):2171-2178. doi: 10.4240/wjgs.v15.i10.2171.
Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.
To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block (TAPB) in gastric cancer patients undergoing laparoscopic radical gastrectomy.
The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group ( = 45) and epidural anesthesia group ( = 40) according to the different anesthesia and analgesia programs used. The TAPB group received general anesthesia combined with TAPB, and the epidural anesthesia group received general anesthesia combined with epidural anesthesia. The pain status, cognitive status, intestinal barrier indicators, recovery quality, and incidence of complications were compared between the two groups.
Compared with the epidural anesthesia group, the TAPB group's visual analog scale scores were significantly lower 6 h, 12 h, 24 h and 48 h after surgery ( < 0.05). The incidence of postoperative cognitive dysfunction (POCD) in the TAPB group was significantly lower than that in the epidural anesthesia group, and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group ( < 0.05). The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery ( < 0.05). The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group ( < 0.05). The total incidence of postoperative complications in the TAPB group was 4.44%, significantly lower than the 20.00% in the epidural anesthesia group ( < 0.05).
Compared with epidural anesthesia combined with general anesthesia, TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications, improve the levels of intestinal barrier indicators, and improve postoperative recovery quality.
术后并发症是影响胃癌根治术患者生存时间和生活质量的重要因素。
探讨并比较静脉全身麻醉联合硬膜外麻醉或超声引导下双侧腹横肌平面阻滞（TAPB）在腹腔镜胃癌根治术患者中的麻醉效果。
回顾性收集2020年12月至2023年1月在我院行腹腔镜胃癌根治术的85例患者的临床资料，根据所采用的不同麻醉和镇痛方案分为TAPB组（n = 45）和硬膜外麻醉组（n = 40）。TAPB组接受全身麻醉联合TAPB，硬膜外麻醉组接受全身麻醉联合硬膜外麻醉。比较两组患者的疼痛状态、认知状态、肠屏障指标、恢复质量及并发症发生率。
与硬膜外麻醉组相比，TAPB组术后6 h、12 h、24 h和48 h的视觉模拟评分显著更低（P < 0.05）。TAPB组术后认知功能障碍（POCD）的发生率显著低于硬膜外麻醉组，且术后24 h的简易精神状态检查表评分TAPB组显著高于硬膜外麻醉组（P < 0.05）。术后24 h，TAPB组的二胺氧化酶和血浆D - 乳酸水平显著低于硬膜外麻醉组（P < 0.05）。TAPB组的躁动评分及恢复期间躁动的发生率显著低于硬膜外麻醉组（P < 0.05）。TAPB组术后并发症总发生率为4.44%，显著低于硬膜外麻醉组的20.00%（P < 0.05）。
与全身麻醉联合硬膜外麻醉相比，全身麻醉联合TAPB在腹腔镜胃癌根治术中具有良好的镇痛效果，可进一步降低POCD和术后并发症的发生率，提高肠屏障指标水平，改善术后恢复质量。
