不同剂量右美托咪定联合罗哌卡因TAPB对腹腔镜腹股沟疝修补术患者免疫炎症反应和认知功能的影响  

Effects of Different Doses of Dexmedetomidine Combined with Ropivacaine TAPB on Immune Inflammatory Response and Cognitive Function in Patients Undergoing Laparoscopic Inguinal Hernia Repair

作　　者：涂茂勇 何文胜[1] 张应涛 丁盼盼[1] 陈帝豪 TU Mao-yong;HE Wen-sheng;ZHANG Ying-tao;DING Pan-pan;CHEN Di-hao(Department of Anesthesiology,The Second People's Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei,Anhui,230011,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)麻醉科,安徽合肥230011

出　　处：《现代生物医学进展》2024年第9期1773-1777,共5页Progress in Modern Biomedicine

基　　金：安徽省自然科学基金项目(1908085MH256)。

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)对腹腔镜腹股沟疝修补术患者免疫炎症反应和认知功能的影响。方法:根据随机数字表法将2020年3月至2022年3月期间合肥市第二人民医院收治的150例腹腔镜腹股沟疝修补术患者分为A组(n=75)、B组(n=75)。两组均采用右美托咪定联合罗哌卡因TAPB,A组给予0.5μg/kg右美托咪定,B组给予1μg/kg右美托咪定。对比两组血流动力学、视觉模拟评分(VAS)、简易智能状态检查量表(MMSE)评分、术后认知功能障碍(POCD)发生率、炎症反应、免疫功能相关指标。结果:与A组手术开始时1 h(T1)、手术结束即刻(T2)时间点相比,B组平均动脉压(MAP)、心率(HR)更低(P<0.05)。B组POCD发生率低于A组(P<0.05)。与A组术后1 d、术后2 d相比,B组MMSE评分更高(P<0.05)。与A组术后12 h、术后24 h、术后48 h相比,B组VAS评分更低(P<0.05)。与A组术后2 d相比,CD8P更低,B组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)更高(P<0.05)。与A组术后2 d相比,B组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)更低(P<0.05)。结论:腹腔镜腹股沟疝修补术患者采用1μg/kg剂量右美托咪定联合罗哌卡因TAPB麻醉,可减轻疼痛感,缓解免疫炎症反应程度,维持血流动力学稳定,同时还可降低POCD发生率。Objective:To investigate the effects of different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block(TAPB)on immune inflammatory response and cognitive function in patients undergoing laparoscopic inguinal hernia repair.Methods:150 patients with laparoscopic inguinal hernia repair who were admitted to the Second People's Hospital of Hefei from March 2020 to March 2022 were divided into group A(n=75)and group B(n=75)according to the random number table method.Both groups were treated with dexmedetomidine combined with ropivacaine TAPB,group A was given 0.5μg/kg dexmedetomidine and group B was given 1μg/kg dexmedetomidine.The hemodynamics,visual analogue scale(VAS),mini-mental state examination(MMSE)score,incidence of postoperative cognitive dysfunction(POCD),inflammatory response and immune function related indicators were compared in two groups.Results:Compared with group A at the beginning of operation 1 h(T1)and immediately after the end of operaion(T2),mean arterial pressure(MAP)and heart rate(HR)were lower in group B(P<0.05).The incidence of POCD in group B was lower than that in group A(P<0.05).Compared with group A 1 d and 2 d after operation,the MMSE score in group B was higher(P<0.05).Compared with group A at 12 h,24 h and 48 h after operation,the VAS score in group B was lower(P<0.05).Compared with group A 2 d after operation,CD8+was lower,and CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) were higher in group B(P<0.05).Compared with group A 2 d after operation,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)were lower in group B(P<0.05).Conclusion:Anesthesia with 1μg/kg dose of dexmedetomidine combined with ropivacaine TAPB in patients undergoing laparoscopic inguinal hernia repair,which can reduce pain,alleviate the degree of immune inflammatory response,maintain hemodynamic stability,and reduce the incidence of POCD.

关 键 词：右美托咪定 罗哌卡因 TAPB 腹腔镜腹股沟疝修补术 炎症反应 免疫功能 认知功能 

分 类 号：R656.21[医药卫生—外科学] R614[医药卫生—临床医学]