| Objective:To observe the changes of quadratus lumborum block（QLB）on perioperative analgesia,inflammatory factors and myocardial enzymes in patients following radical gastrectomy for gastric cancer,preliminarily explore the clinical effect of ultrasound-guided quadratus lumborum block on myocardial injury in elderly patients undergoing radical gastrectomy.Methods:from December 2020 to December 2021 line during laparoscopic assisted the 62 cases of elderly patients with gastric cancer radical included in this study.Inclusion criteria:ASA physical statusⅠ-Ⅲ;Aged from 65～75 years old;BMI from 18.5～26.9kg/m2.Exclusion criteria:Have a history of chronic pain or take opioid analgesics;Coagulation dysfunction or bleeding tendency;Infection at the puncture site of abdomen;Those who refuse to use postoperative analgesia;preoperative patients with coronary heart disease,cardio myopathy,cerebral infarction,cerebral hemorrhage and other major diseases.The patients were randomly divided into two groups（n=30）:ultrasound-guided quadratus lumborum block group（group Q）and control group（group C）.Patients in group Q received ultrasound-guided quadratus lumborum block before operation,while patients in group C did not received regional block.All patients received patient controlled intravenous analgesia（PCIA）pump after operation.PCIA pump contained butorphanol bitartrate and normal saline in a total volume of100ml.When the resting VAS score was more than 3 points,the patients were self-controlled analgesia.If it still did not improve,1 mg of butorphanol was injected intramuscularly for remedial analgesia.Record the amount of analgesics used during operation;Mean arterial pressure（MAP）and heart rate（HR）before anesthesia induction（T1）,immediately after surgery（T2）,6 hours after surgery（T3）,24 hours after surgery（T4）,and 48 hours after surgery（T5）.At the same time,the peripheral venous blood of the patient was sampled for troponin I（c Tn I）,creatine kinase（CK）,creatine kinase isoenzyme（CK-MB）and lactate dehydrogenase（LDH）;Take venous blood at T1 and T4 to detect serum tumor necrosis factor-α（TNF-α）,Interleukin-6（IL-6）;T3,T4,T5 resting visual analogue scores,the number of intravenous pump press,the total amount of application and the number of relief analgesia within 48 hours after operation.Results:Comparison among groups:The dosage of remifentanil used during operation in group Q was significantly reduced（P<0.05）.Within 24hours after operation,HR in group Q was significantly slower and MAP was significantly lower than that in group C（P<0.05）.Within 24 hours after operation,The VAS scores of the group Q were significantly lower than those of the group C.The number of effective compressions and the numbers of remedial analgesia in patients.within 48 hours after operation were significantly lower than those in group C（P<0.05）.Within 48h hours after operation,TNF-αand IL-6 concentrations of serum in group Q was significantly lower than group C（P<0.05）.At 6h,24h and 48h after operation,c Tn I in group Q was significantly lower than that in group C（P<0.05）Intragroup comparison:Compared with before anesthesia induction,IL-6and TNF-αin the two groups was significantly higher than 24 hours after operation.Compared with that before anesthesia induction,LDH in the two groups immediately after operation,6h after operation and 24h after operation,CK in the two groups immediately after operation,6h after operation,24h after operation and 48h after operation,CK-MB in two groups at 6h and 24h after operation,c Tn I in the two groups increased significantly at 6h,24h and 48h after operation（P<0.05）.Conclusion:General anesthesia combined with ultrasound-guided quadratus lumborum block has a definite analgesic effect on elderly patients undergoing laparoscopic radical gastrectomy,which can significantly reduce the dose of analgesic drugs during operation,reduce the release of inflammatory factors in patients after operation,inhibit the cardiovascular reaction during and after operation,and thus reduce the perioperative myocardial injury of patients... |
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