[1]张红伟,王卫卫,李晓芳,等.罗哌卡因联合右美托咪定腹横肌平面阻滞对腹腔镜胃癌根治术患者术后应激激素及认知功能的影响[J].新乡医学院学报,2024,(3):245-250.[doi:10.7683/xxyxyxb.2024.03.009]
　ZHANG Hongwei,WANG Weiwei,LI Xiaofang,et al.Effect of ropivacaine combined with dexmedetomidine in transversus abdominis plane block on postoperative stress hormone and cognitive function in patients undergoing laparoscopic radical gastrectomy[J].Journal of Xinxiang Medical University,2024,(3):245-250.[doi:10.7683/xxyxyxb.2024.03.009]
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罗哌卡因联合右美托咪定腹横肌平面阻滞对腹腔镜胃癌根治术患者术后应激激素及认知功能的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年3
页码:
245-250
栏目:
临床研究
出版日期:
2024-03-05

文章信息/Info

Title:
Effect of ropivacaine combined with dexmedetomidine in transversus abdominis plane block on postoperative stress hormone and cognitive function in patients undergoing laparoscopic radical gastrectomy
作者:
张红伟1; 王卫卫2; 李晓芳1; 樊藤1; 马文珂1; 岳修勤1
（1.新乡医学院第一附属医院麻醉与围术期医学科，河南　卫辉　453100；2.新乡医学院第一附属医院新生儿科，河南　卫辉　453100）
Author(s):
ZHANG Hongwei1; WANG Weiwei2; LI Xiaofang1; FAN Teng1; MA Wenke1; YUE Xiuqin1
(1.Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;2.Department of Neonatology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
右美托咪定; 应激激素; 腹横肌平面阻滞; 胃癌根治术; 认知功能
Keywords:
dexmedetomidine; stress hormones; transversus abdominis plane block; radical gastrectomy; cognitive function
分类号:
R735.2
DOI:
10.7683/xxyxyxb.2024.03.009
文献标志码:
A
摘要:
目的　探讨罗哌卡因联合右美托咪定腹横肌平面阻滞对腹腔镜胃癌根治术患者术后应激激素及认知功能的影响。
方法　选择2023年4至10月于新乡医学院第一附属医院行腹腔镜胃癌根治术的80例患者为研究对象，根据麻醉方法不同将患者分为观察组和对照组，每组40例。观察组患者注射2.5 g·L-1罗哌卡因与右美托咪定（0.5 μg·kg-1）混合液行双侧腹横肌平面阻滞，每侧注射20 mL；对照组患者注射2.5 g·L-1罗哌卡因行双侧腹横肌平面阻滞，每侧注射20 mL。记录患者入手术室（T1）、气管插管后即刻（T2）、气腹后40 min（T3）、气管拔管后15 min（T4）的平均动脉压（MAP）、心率（HR）。于术后1、6、12、24 h，应用放射性免疫沉淀法检测血清中皮质醇(COR)水平，酶联免疫吸附试验法检测血清中去甲肾上腺素(NE)、肾上腺素(E)水平，视觉模拟评分法（VAS）评估患者静息状态下疼痛程度，Ramsay评分（RSS）评估患者的镇静深度。比较2组患者丙泊酚及舒芬太尼的用量。于术前1 d、术后1 d、术后3 d，应用酶联免疫吸附试验法检测2组患者血清中β淀粉样蛋白（Aβ）及S100β蛋白水平，使用简易智力状态检查量表（MMSE）评估患者的认知功能。
结果　T1、T2时，对照组与观察组患者的MAP和HR比较差异无统计学意义（P>0.05）；T3、T4时，观察组患者的MAP和HR显著低于对照组（P<0.05）。术后1、6、12 h，观察组患者的VAS评分显著低于对照组（P<0.05）；术后24 h，对照组与观察组患者的VAS评分比较差异无统计学意义（P>0.05）。术后1、6 h，观察组患者的Ramsay评分显著高于对照组（P<0.05）；术后12、24 h，对照组与观察组患者的Ramsay评分比较差异无统计学意义（P>0.05）。术后1、6、12 h，观察组患者血清中COR、NE和E水平显著低于对照组（P<0.05）；术后24 h，对照组与观察组患者血清中COR、NE和E水平比较差异无统计学意义（P>0.05）。观察组患者的丙泊酚及舒芬太尼的用量显著少于对照组（P<0.05）。术前1 d，对照组与观察组患者的MMSE评分比较差异无统计学意义（P>0.05）；术后1、3 d，观察组患者的MMSE评分显著高于对照组（P<0.05）。术前1 d，对照组与观察组患者血清中Aβ和S100β 蛋白水平比较差异无统计学意义（P>0.05）。术后1、3 d，观察组患者血清中Aβ和S100β 蛋白水平显著低于对照组（P<0.05）。
结论　罗哌卡因联合右美托咪定腹横肌平面阻滞在胃癌根治术中可显著降低术后疼痛，增加镇静效果，延长腹横肌神经阻滞时间，且有利于患者术后苏醒，减轻认知功能的受损程度。
Abstract:
Objective　To explore the effect of ropivacaine combined with dexmedetomidine in transversus abdominis plane block (TAPB) on postoperative stress hormones and cognitive function in patients undergoing laparoscopic radical gastrectomy.
Methods　A total of 80 patients undergoing laparoscopic radical gastrectomy at the First Affiliated Hospital of Xinxiang Medical University from April to October 2023 were selected as the research subjects.According to different anesthesia methods,the patients were divided into the observation group and the control group,with 40 patients in each group.Patients in the observation group were injected bilaterally with 2.5 g·L-1 ropivacaine and 0.5 μg·kg-1 dexmedetomidine for TAPB,with 20 mL injection on each side.Patients in the control group were injected bilaterally with 2.5 g·L-1 ropivacaine for TAPB,with 20 mL injection on each side.Mean arterial pressure (MAP) and heart rate (HR) were recorded at the time of admission to the operating room (T1),immediately after endotracheal intubation (T2),40 minutes after pneumoperitoneum (T3),and 15 minutes after extubation (T4).Radioimmunoprecipitation was used to detect serum cortisol (COR) level,and enzyme-linked immunosorbent assay was used to measure serum norepinephrine (NE) and epinephrine (E) levels at 1,6,12,and 24 hours after surgery.Visual analog scale (VAS) was used to assess pain at rest,and Ramsay sedation scale (RSS) was used to evaluate sedation depth.The doses of propofol and sufentanil were compared between the two groups.Serum β-amyloid (Aβ) and S100β protein levels at 1 day before surgery,1 and 3 days after surgery were detected by using the enzyme-linked immunosorbent assay,and cognitive function was assessed at the same time points by using the mini-mental state examination (MMSE).
Results　At T1 and T2,there was no significant difference in MAP and HR between the control group and the observation group (P>0.05).At T3 and T4,MAP and HR in the observation group were significantly lower than those in the control group (P<0.05).At 1,6,and 12 hours postoperatively,VAS score in the observation group was significantly lower than that in the control group (P<0.05).At 24 hours postoperatively,there was no significant difference in VAS score between the control group and observation group (P>0.05).At 1 and 6 hours postoperatively,RSS score in the observation group was significantly higher than that in the control group (P<0.05).At 12 and 24 hours postoperatively,there was no significant difference in RSS score between the control group and observation group (P>0.05).At 1,6,and 12 hours postoperatively,COR,NE,and E levels in the observation group were significantly lower than those in the control group (P<0.05).At 24 hours postoperatively,there was no significant difference in COR,NE,and E levels between the control group and observation group (P>0.05).The doses of propofol and sufentanil in the observation group were significantly lower than those in the control group (P<0.05).One day before surgery,there was no significant difference in MMSE score between the control group and observation group (P>0.05).At 1 and 3 days postoperatively,MMSE score in the observation group was significantly higher than that in the control group (P<0.05).One day before surgery,there was no significant difference in serum Aβ and S100β protein levels between the control group and observation group (P>0.05).At 1 and 3 days postoperatively,serum Aβ and S100β protein levels in the observation group were significantly lower than those in the control group (P<0.05).
Conclusion　Ropivacaine combined with dexmedetomidine in TAPB in radical gastrectomy can significantly reduce postoperative pain,increase sedative effect,prolong the duration of TAPB,and benefit patients′ postoperative recovery with reduced cognitive impairment.

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更新日期/Last Update: 2024-03-05