腹腔镜输卵管切除术后右美托咪定联合布托啡诺镇痛效果及对患者应激反应影响  

Effect of dexmedetomidine combined with butorphanol for postoperative analgesia after laparoscopic salpingectomy and its influence on the stress reaction

作　　者：刘晶涛[1] 杨艳[1] LIU Jingtao;YANG Yan(Anyang District Hospital,Puyang,Henan Province,455000)

机构地区：[1]河南省濮阳市安阳地区医院,455000

出　　处：《中国计划生育学杂志》2022年第11期2447-2451,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨右美托咪定联合布托啡诺对腹腔镜输卵管切除术后镇痛及血清抗中肾旁管激素(AMH)、肿瘤坏死因子-α(TNF-α)表达的影响。方法:选取2020年3月-2021年8月本院拟行腹腔镜输卵管切除术患者108例,随机数字表法随机分为单一组(54例)和联合组(54例),常规麻醉诱导后均给予腹横肌平面阻滞(0.25%罗哌卡因),静脉滴注右美托咪定,联合组联合布托啡诺。比较两组不同时刻血清AMH、TNF-α水平、48h内镇痛效果[疼痛视觉模拟评分(VAS)]、术中丙泊酚及瑞芬太尼用量、镇痛泵按压次数及不良反应发生率。结果:拔管即刻、术后24h、术后48h,联合组血清AMH(1.26±0.48μg/L、1.22±0.47μg/L、1.21±0.43μg/L)均高于单一组(1.06±0.49μg/L、1.02±0.52μg/L、1.02±0.46μg/L),TNF-α(1.33±0.45 ng/ml、1.13±0.42 ng/ml、1.41±0.23 ng/ml)均低于单一组(2.46±0.57 ng/ml、1.68±0.51 ng/ml、1.26±0.48 ng/ml),联合组术后8h、12h、24h VAS评分均低于单一组,术中丙泊酚(412.37±63.27 mg)及瑞芬太尼(736.54±92.16μg)用量均少于单一组(783.26±96.78 mg、446.54±72.56μg),术后4h、8h、12h、24h、48h镇痛泵按压次数均少于单一组(均P<0.05);不良反应总发生率联合组(9.3%)与单一组(7.4%)无差异(P>0.05)。结论:右美托咪定联合布托啡诺用于腹腔镜输卵管切除术镇痛效果提高,且能够缓解患者应激反应,减少丙泊酚及瑞芬太尼用量,未增加不良反应。Objective:To investigate the effect of dexmedetomidine combined with butorphanol for analgesia of patients after laparoscopic salpingectomy,and to study its influence on the expression level of serum anti-müllerian hormone(AMH)and tumor necrosis factor-α(TNF-α)of these patients.Methods:108 patients requiring laparoscopic salpingectomy were selected and randomly divided into group A(54 cases)and group B(54 cases)by random number table method from March 2020 to August 2021.After routine anesthesia induction,the patients in the two groups were given horizontal block of transverse abdominal muscle(injection of 0.25%ropivacaine).Then the patients in group A were intravenously injected with dexmedetomidine,and the patients in group B were intravenously injected with dexmedetomidine and butorphanol.The levels of serum AMH and TNF-αat different times,the analgesic effect within 48 hours by pain visual analogue scale(VAS),the intraoperative propofol and remifentanil dosages,the number of compressions of analgesic pump,and the incidence of adverse reactions of the patients were compared between the two groups.Results:The serum AMH level of the patients in group B immediately after extubation,24h and 48h after operation were 1.26±0.48μg/L,1.22±0.47μg/L,and 1.21±0.43μg/L,respectively,which were significantly higher than those(1.06±0.49μg/L,1.02±0.52μg/L,and 1.02±0.46μg/L,respectively)of the patients in group A.The serum TNF-αlevel of the patients in group B immediately after extubation,24h and 48h after operation were 1.33±0.45 ng/ml,1.13±0.42 ng/ml,and 1.41±0.23 ng/ml,respectively,which were significantly lower than those(2.46±0.57 ng/ml,1.68±0.51 ng/ml,and 1.26±0.48 ng/ml,respectively)of the patients in group A.The VAS scores at 8h,12h,and 24h after operation of the patients in group B were significantly lower than those of the patients in group A.The intraoperative doses of propofol(412.37±63.27 mg)and remifentanil(736.54±92.16μg)of the patients in group B were significantly lower than those(783.

关 键 词：腹腔镜输卵管切除术 右美托咪定 布托啡诺 腹横肌平面阻滞 术后镇痛 应激反应 药物用量 

分 类 号：R614[医药卫生—麻醉学]