不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞在腹腔镜胃肠手术中的镇痛效果及对患者认知功能的影响  

Analgesic effect of different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block on laparoscopic gastrointestinal surgery and its influence on patients’cognitive function

作　　者：陈浩[1] 李慧利[1] 周长浩[1] 王欣[1] 陈欢[1] Chen Hao;Li Huili;Zhou Changhao;Wang Xin;Chen Huan(Department of Anesthesia and Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050001,China)

机构地区：[1]河北医科大学第一医院麻醉手术科,石家庄050001

出　　处：《中国医药》2021年第4期575-578,共4页China Medicine

基　　金：河北省医学科学研究课题计划(20190443)。

摘　　要：目的探讨不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞(TAPB)用于腹腔镜下胃肠手术患者的镇痛效果及对患者术后认知功能的影响。方法选取河北医科大学第一医院2018年1月至2019年12月收治的拟行腹腔镜胃肠手术的患者100例,采用随机数字表法分为对照组和观察组,各50例。对照组术前给予0.75μg/kg右美托咪定联合罗哌卡因进行TAPB,观察组术前给予1.0μg/kg右美托咪定联合罗哌卡因进行TAPB,2组术后均给予罗哌卡因联合2μg/kg右美托咪定持续48 h镇痛。比较2组术前和术后12、24、48 h疼痛视觉模拟量表(VAS)评分,术前1 d和术后1、2、5 d蒙特利尔认知评估量表(MoCA)和简易智力测评量表(MMSE)评分,以及术后1、2、5 d认知功能障碍的发生率。结果术前,2组VAS评分比较差异无统计学意义(P>0.05);术后12、24、48 h 2组患者VAS评分均逐渐降低,且术后各时点观察组VAS评分均低于对照组[(1.61±0.43)分比(3.14±0.91)分,(1.18±0.28)分比(2.19±0.65)分,(0.88±0.44)分比(1.91±0.70)分](均P<0.05)。术前1 d和术后5 d,观察组MMSE和MoCA评分与对照组比较差异均无统计学意义(均P>0.05);术后1、2 d,观察组MMSE和MoCA评分均高于对照组(均P<0.05)。术后1 d,观察组认知功能障碍发生率低于对照组[26.0%(13/50)比52.0%(26/50)],差异有统计学意义(P=0.008),而术后2、5 d与对照组比较差异均无统计学意义(均P>0.05)。结论与术前给予0.75μg/kg右美托咪定联合罗哌卡因进行TAPB比较,术前给予1.0μg/kg右美托咪定联合罗哌卡因进行TAPB对腹腔镜胃肠道手术患者具有更好的镇痛效果,且对患者术后认知功能的影响更小。Objective To investigate the analgesic effect of different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block(TAPB)on patients undergoing laparoscopic gastrointestinal surgery and its influence on postoperative cognitive function.Methods From January 2018 to December 2019,100 patients undergoing laparoscopic gastrointestinal surgery in the First Hospital of Hebei Medical University were selected.They were randomly divided into control group and observation group,with 50 cases in each group.The control group was given 0.75μg/kg dexmedetomidine combined with ropivacaine for TAPB before operation,while the observation group was given 1.0μg/kg dexmedetomidine combined with ropivacaine for TAPB before operation.Both groups were given ropivacaine combined with 2μg/kg dexmedetomidine for 48 h after operation.The visual analogue scale(VAS)scores of pain before operation and 12,24 and 48 h after operation,Montreal Cognitive Assessment Scale(MoCA)and mini mental assessment scale(MMSE)scores were compared between the two groups 1 d before operation and 1,2,5 d after operation,and the incidence of postoperative cognitive dysfunction(POCD)1,2,5 d after operation.Results There was no significant difference in VAS scores between the two groups before operation(P>0.05);the VAS scores of the two groups were gradually decreased at 12,24 and 48 h after operation,and the VAS scores of the observation group were lower than those of the control group at each time point after operation[(1.61±0.43)vs(3.14±0.91),(1.18±0.28)vs(2.19±0.65),(0.88±0.44)vs(1.91±0.70)](all P<0.05).There were no significant differences in MMSE and MoCA scores between the observation group and the control group at 1 d before operation and 5 d after operation(all P>0.05);at 1 and 2 d after operation,the scores of MMSE and MoC A in the observation group were higher than those in the control group(all P<0.05).At 1 d after operation,the incidence of POCD in observation group was lower than that in control group[26.0%(13/50)v

关 键 词：腹横肌平面阻滞 右美托咪定 罗哌卡因 认知功能 

分 类 号：R614[医药卫生—麻醉学]