罗哌卡因联合右美托咪定局部阻滞麻醉在老年腹腔镜下无张力疝修补术中的应用  

Application of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair

作　　者：袁志静 黄杰 何国安 方辉强 Zhijing Yuan;Jie Huang;Guoan He;Huiqiang Fang(Department of Anesthesiology,People's Hospital of Ningguo City,Ningguo 242300,Anhui Province,China)

机构地区：[1]安徽省宁国市人民医院麻醉科,242300

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第5期557-561,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：安徽省卫生健康科研项目(AHWJ2022c019)。

摘　　要：目的探讨罗哌卡因联合右美托咪定局部阻滞麻醉在老年腹腔镜下无张力疝修补术中的应用。方法选取2022年2月至2023年9月在宁国市人民医院行腹腔镜下无张力疝修补术的老年患者80例,按照随机数表法分为对照组(42例)与观察组(38例),所有患者均接受局部阻滞麻醉,对照组仅应用罗哌卡因阻滞,观察组应用罗哌卡因联合右美托咪定阻滞。对比2组临床指标、镇痛效果、应激反应及麻醉不良反应,分析麻醉阻滞前(T0)、麻醉阻滞10 min后(T1)、切皮时(T2)、手术30 min后(T3)及手术结束时(T4)血流动力学变化。结果观察组阻滞起效及摘除喉罩的时间均明显短于对照组(P<0.05),2组麻醉苏醒时间差异无统计学意义(P>0.05)。T0~T1时刻,2组心率(HR)、平均动脉压(MAP)均下降,但观察组HR、MAP均高于对照组,差异有统计学意义(P<0.05);T2~T4时刻,观察组HR、血氧饱和度及MAP水平均高于对照组,差异无统计学意义(P>0.05);术后3、5 d,观察组去甲肾上腺素、皮质醇水平均显著低于对照组(P<0.05);2组围手术期不良反应发生率差异无统计学意义(P>0.05)。结论对老年腹腔镜下无张力疝修补术患者予以罗哌卡因联合右美托咪定局部阻滞能维持血流动力学稳定,降低应激反应,且安全性较好。Objective To investigate the application effect of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair.Methods A total of 80 elderly patients who underwent laparoscopic tension-free inguinal hernia repair in People&apos;s Hospital of Ningguo City from February 2022 to September 2023 were selected.Patients were divided into control group(ropivacaine 42 cases)and experimental group(ropivacaine and dexmedetomidine 38 cases)using the random number table method.All patients received local block anesthesia,the control group received ropivacaine,while the experimental group received ropivacaine combined with dexmedetomidine.Clinical indicators,analgesic effects,stress reactions,and anesthesia adverse reactions were compared between the two groups.Hemodynamic changes before block anesthesia(T0),at 10 minutes after block anesthesia(T1),at skin incision(T2),at 30 minutes after surgery(T3)and at the end of surgery(T4)were analyzed.Results The block onset time and removal time of laryngeal mask in the experimental group were significantly shorter as compared with the control group(P<0.05).There was no significant difference in anesthesia recovery time between the two groups(P>0.05).From T0 to T1,heart rate(HR)and mean arterial pressure(MAP)of both groups decreased,but the experimental group had higher HR and MAP than the control group,and the difference was statistically significant(P<0.05).From T2 to T4,the experimental group had higher HR,blood oxygen saturation and MAP than the control group,but the differences were not statistically significant(P>0.05).On the 3rd and 5th day after surgery,the levels of norepinephrine and cortisol in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence rates of perioperative adverse reactions between the two groups(P>0.05).Conclusion Applying local block with ropivacaine and dexmedetomidine in elderly patients under

关 键 词：罗哌卡因 右美托咪定 局部阻滞 无张力疝修补术 腹腔镜 老年人 

分 类 号：R614[医药卫生—麻醉学] R656.2[医药卫生—外科学]