地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者镇痛效果及围术期免疫和应激反应影响  

Analgesic Effects of Dezocine Intravenous Anesthesia Combined with Ropivacaine Local Infiltration Anesthesia onPatients Undergoing Laparoscopic Radical Resection of Colorectal Cancer and Their Effect on PerioperativeImmune Function and Stress Response

作　　者：王艳丽[1] 王梦迪 何会珍[1] WANG Yanli;WANG Mengdi;HE Huizhen(Department of Anesthesiology,the Second Central Hospital of Baoding City,Baoding,Hebei 072750,China)

机构地区：[1]保定市第二中心医院麻醉科,河北保定072750

出　　处：《临床误诊误治》2024年第4期80-84,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科技计划项目(214ZF215)。

摘　　要：目的探讨腹腔镜结直肠癌根治术患者使用地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛效果及对围术期免疫和应激反应影响。方法选取2020年4月—2022年5月择期行腹腔镜结直肠癌根治术患者100例,据麻醉镇痛方式不同均分为观察组和对照组,观察组给予全麻及地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛,对照组给予全麻及罗哌卡因局部浸润麻醉镇痛。记录2组麻醉诱导前5 min(T0)、术毕(T1)、拔管即刻(T2)、拔管后30 min(T3)、拔管后60 min(T4)时平均动脉压(MAP)、心率(HR)及血清皮质醇(Cor)、丙二醛(MDA)水平;比较术前、术后24 h 2组外周血CD4+、CD8+和CD4+/CD8+水平,术毕12、24、48 h视觉模拟评分法(VAS)评分,术前、术后3 d简易智力状态检查量表(MMSE)评分,以及2组麻醉恢复期间不良反应。结果T3时,2组MAP、HR高于T0时,且观察组低于对照组(P<0.05);T1、T2、T3、T4时,2组Cor、MDA均高于T0时,且观察组低于对照组(P<0.05)。术后24 h,2组CD4+、CD4+/CD8+降低,CD8+升高,且观察组CD4+、CD4+/CD8+较对照组升高,CD8+较对照组降低(P<0.05)。观察组术毕12、24、48 h VAS评分均较对照组降低(P<0.05)。术后3 d,2组MMSE评分均降低,且观察组低于对照组(P<0.05)。观察组麻醉恢复期间躁动发生率为6.00%(3/50)低于对照组的20.00%(10/50)(P<0.05)。结论全麻及地佐辛静脉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者免疫功能影响小,可减轻手术应激,镇痛效果好,且安全性高。Objective To investigate the analgesic effects of Dezocine intravenous anesthesia combined with Ropivacaine local infiltration anesthesia on patients undergoing laparoscopic radical resection of colorectal cancer(CRC)and their effect on perioperative immune function and stress response.Methods A total of 100 patients who underwent laparoscopic radical resection for CRC from April 2020 to May 2022 were selected and divided into observation group and control group according to different anesthesia methods.The observation group was given Dezocine intravenous anesthesia combined with Ropivacaine local infiltration anesthesia,and the control group was given Ropivacaine local infiltration anesthesia.The mean arterial pressure(MAP),heart rate(HR),serum cortisol(Cor)and malondialdehyde(MDA)levels were recorded in the two groups at 5 min before anesthesia induction(T0),after surgery(T1),immediately after extubation(T2),at 30 min after extubation(T3),and at 60 min after extubation(T4).The levels of peripheral blood CD4+,CD8+and CD4+/CD8+before and at 24 h after surgery in the two groups were compared,the scores of visual analogue scale(VAS)at 12,24 and 48 h after completion of surgery,the scores of the Mini-Mental State Examination Scale(MMSE)before and at 3 d after surgery,and the adverse reactions in the recovery period of anesthesia in the two groups were compared.Results MAP and HR at T3 were higher than those at T0 in the two groups,which were lower in the observation group than in the control group(P<0.05).Cor and MDA at T1,T2,T3 and T4 were higher than those at T0,which were lower in the observation group than in the control group(P<0.05).At 24 h after surgery,CD4+and CD4+/CD8+decreased and CD8+increased in the two groups;CD4+and CD4+/CD8+increased in observation group compared with control group,and CD8+decreased compared with control group(P<0.05).VAS scores of the observation group at 12,24 and 48 h after completion of surgery were lower than those of the control group(P<0.05).At 3 d after surgery,MMSE scores in

关 键 词：结直肠肿瘤 腹腔镜结直肠癌根治术 麻醉 镇痛 地佐辛 罗哌卡因 平均动脉压 CD4+ 

分 类 号：R735.37[医药卫生—肿瘤]