不同浓度罗哌卡因超声引导腹横肌平面阻滞用于腹腔镜袖状胃切除术患者对术后疼痛及应激反应的影响  

The effect of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy

作　　者：周民[1] 刘仁齐 王芷怡 张茂华 Zhou Min;Liu Renji;Wang Zhiyi;Zhang Maohua(Department of Anesthesiology,Puren Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430081,China)

机构地区：[1]武汉科技大学附属普仁医院麻醉科,武汉430081

出　　处：《中国医师杂志》2024年第1期93-97,共5页Journal of Chinese Physician

基　　金：2017年度职业危害识别与控制湖北省重点实验室开放基金项目(OHIC2018K02)。

摘　　要：目的探讨不同浓度罗哌卡因超声引导腹横肌平面阻滞用于腹腔镜袖状胃切除术患者对术后疼痛及应激反应的影响。方法前瞻性选取2020年7月至2022年7月期间在武汉科技大学附属普仁医院行腹腔镜袖状胃切除术的120例肥胖症患者为研究对象。依据随机数字表法将所有患者分为对照组、低浓度组和高浓度组,每组40例。三组均在全麻诱导后行超声引导腹横肌平面阻滞,对照组注射生理盐水,低浓度组、高浓度组分别注射0.25%、0.50%浓度罗哌卡因。比较三组手术前后的应激反应指标[肾上腺素(E)、皮质醇(Cor)、游离甲状腺素(FT4)和C反应蛋白(CRP)]、血流动力学指标[平均动脉压(MAP)和心率(HR)]、糖脂代谢指标[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA_(1c))、总胆固醇(TC)和甘油三酯(TG)]和视觉模拟量表(VAS)评分。结果术后1 d,高浓度组E、Cor、FT4、CRP、FBG、2 h PBG、HbA_(1c)、TC和TG水平均低于对照组、低浓度组(均P<0.05);麻醉后15 min、术后2 h,高浓度组MAP、HR均高于对照组、低浓度组(均P<0.05);术后6、12、24 h,高浓度组VAS评分均低于对照组、低浓度组(均P<0.05);三组麻醉诱导期间气道反应发生率比较差异无统计学意义(P>0.05)。结论腹腔镜袖状胃切除术中,给予患者0.50%浓度罗哌卡因超声引导腹横肌平面阻滞,其术后镇痛作用较强,能较好地改善E、Cor、FT4和CRP水平,值得临床应用。Objective To explore the effects of different concentrations of ropivacaine ultrasound-guided transverse abdominis plane block on postoperative pain and stress response in patients undergoing laparoscopic sleeve gastrectomy.Methods A prospective study was conducted on 120 obese patients who underwent laparoscopic sleeve gastrectomy at the Puren Hospital Affiliated to Wuhan University of Science and Technology from July 2020 to July 2022.According to the random number table method,all patients were divided into a control group,a low concentration group,and a high concentration group,with 40 cases in each group.All three groups underwent ultrasound-guided transverse abdominis plane block after general anesthesia induction.The control group was injected with physiological saline,while the low concentration group and high concentration group were injected with 0.25% and 0.50% ropivacaine,respectively.Stress response indicators before and after surgery in three groups[adrenaline(E),cortisol(Cor),free thyroxine(FT4),and C-reactive protein(CRP)],hemodynamic indicators[mean arterial pressure(MAP)and heart rate(HR)],glucose and lipid metabolism indicators[fasting blood glucose(FBG),2-hour postprandial blood glucose(2-hour PBG),glycated hemoglobin(HbA_(1c)),total cholesterol(TC),and triglycerides(TG)]and Visual Analog Scale(VAS)score were compared before and after surgery.Results On the 1st day after surgery,the levels of E,Cor,FT4,CRP,FBG,2-hour PBG,HbA_(1c),TC,and TG in the high concentration group were lower than those in the control group and low concentration group(all P<0.05);15 minutes after anesthesia and 2 hours after surgery,the MAP and HR of the high concentration group were higher than those of the control group and the low concentration group(all P<0.05);At 6,12,and 24 hours after surgery,the VAS score of the high concentration group was lower than that of the control group and the low concentration group(all P<0.05);There was no statistically significant difference in the incidence of airway reactions during

关 键 词：罗哌卡因 神经传导阻滞 胃切除术 腹腔镜检查 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]