DEX复合罗哌卡因对全麻腹腔镜全子宫切除术患者术后镇痛效果及免疫功能的影响  

Effect of dexmedetomidine combined with ropivacaine used in transversus abdominis plane block on postoperative analgesia,sedation and immune function in patients treated with laparoscopic hysterectomy with general anesthesia

作　　者：王静 李萌盟 方红双 刘晓梦 张丽燕 WANG Jing;LI Mengmeng;FANG Hongshuang(Department of Anesthesiology,the Sixth People’s Hospital of Hengshui,Hebei,Hengshui 053200,China)

机构地区：[1]河北省衡水市第六人民医院麻醉科,053200

出　　处：《河北医药》2023年第13期1964-1967,1971,共5页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20221508)。

摘　　要：目的探讨右美托咪定(DEX)复合罗哌卡因腹横肌平面阻滞(TAPB)对行全麻腹腔镜全子宫切除术患者术后镇痛镇静效果及免疫功能的影响。方法选取2020年5月至2022年5月收治的行全麻腹腔镜全子宫切除术患者136例,随机数字表法分为对照组和观察组,每组68例。2组均在麻醉诱导前实施超声引导下TAPB,其中对照组使用罗哌卡因,观察组在对照组基础上联合DEX,2组均于术后观察48 h。比较2组的围手术期指标,不同时点的应激反应及免疫功能,T1、T2的Ramsay评分、数字疼痛评分法(NRS)、伯格曼舒适度量表(BSC)评分,术后48 h的不良反应发生情况。结果观察组麻醉苏醒时间、拔管时间短于对照组(P<0.05);T0~T32组心率(HR)、平均动脉压(MAP)及外周血CD4^(+)T细胞、CD4^(+)/CD8^(+)水平呈先降低后升高趋势,观察组T1、T3高于对照组(P<0.05);T0~T32组血浆皮质醇(Cor)、去甲肾上腺素(NE)水平呈先升高后降低趋势,观察组T1、T3低于对照组(P<0.05);T1、T22组静息状态NRS评分、活动状态NRS评分降低,其中观察组低于对照组,Ramsay评分均降低,观察组高于对照组(P<0.05);T1、T22组BSC评分升高,其中观察组高于对照组(P<0.05);观察组术后48 h的不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论DEX复合罗哌卡因TAPB应用于全麻腹腔镜全子宫切除术可减轻患者机体应激反应,改善免疫功能,镇痛镇静效果较好,利于术后恢复,安全性较高。Objective To investigate the effect of dexmedetomidine(DEX)combined with ropivacaine used in transversus abdominis plane block(TAPB)on postoperative analgesia,sedation and immune function in patients treated with total laparoscopic hysterectomy(TLH)under general anesthesia.Methods From May 2020 to May 2022,a total of 136 patients who underwent TLH under general anesthesia in our hospital were recruited.They were randomly allocated to the control group(n=68)and the observation group(n=68).Patients in both groups were managed by ultrasound-guided TAPB before the induction of anesthesia.Ropivacaine was given to all patients,and those in the observation group were additionally given DEX.All patients were observed for 48 hours postoperatively.The perioperative indexes,stress response and immune function at different time points(T0-T3),the scores of Ramsay Sedation Scale(RSS),Numerical Rating Scale(NRS),and Bruggrmann comfort scale(BCS)at T1 and T2,and adverse events within 48 hours postoperatively were compared between groups.Results The recovery time and extubation time of the observation group were significantly shorter than those of the control group(P<0.05).The heart rate(HR),mean arterial pressure(MAP),peripheral blood CD4^(+)T cells,CD4^(+)/CD8^(+)levels at T0 to T3 in both groups were reduced and then enhanced,which,at T1 and T3,were significantly higher in the observation group than in the control group(P<0.05).Plasma cortisol(Cor)and norepinephrine(NE)levels at T0 to T3 in both groups were enhanced and then reduced,which,at T1 and T3,were significantly lower in the observation group than in the control group(P<0.05).At T1 and T2,NRS scores at both the resting and active state in both groups were reduced,which were significantly lower in the observation group than in control group(P<0.05).The RSS scores were reduced in both groups,which were significantly higher in the observation group than in control group(P<0.05).BCS scores at T1 and T2 in both groups were elevated,which were significantly higher in the obs

关 键 词：右美托咪定 罗哌卡因 腹横肌平面阻滞 腹腔镜 全子宫切除术 镇痛镇静 免疫功能 

分 类 号：R713.4[医药卫生—妇产科学]