右美托咪定联合罗哌卡因行腰方肌阻滞对腹腔镜全子宫切除术患者术后镇痛、炎症反应、早期认知功能、血流动力学影响  

Effects of dexmedetomidine combined with ropivacaine for quadratus lumborum block during laparoscopic total hysterectomy of patients on their postoperative analgesia, inflammation, early cognitive function and hemodynamics

作　　者：刘静 李大伟 裴素云 LIU Jing;LI Dawei;PEI Suyun(Linquan County People's Hospital,Linquan,Anhui Province,236400;The Second Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui Province)

机构地区：[1]安徽省临泉县人民医院,236400 [2]蚌埠医科大学第二附属医院

出　　处：《中国计划生育学杂志》2025年第2期305-310,共6页Chinese Journal of Family Planning

摘　　要：目的:观察右美托咪定(Dex)联合罗哌卡因(Rop)行腰方肌阻滞(QLB)对腹腔镜全子宫切除术患者术后镇痛、炎症反应、早期认知功能、血流动力学影响。方法:纳入2022年1月-2024年5月在本院行腹腔镜全子宫切除术的子宫肌瘤患者100例,随机分为对照组和观察组各50例,在QLB中,对照组每侧注射0.2%Rop 30ml,观察组每侧注射0.50g/kgDex、0.2%Rop 30ml。记录并比较两组手术前后镇痛[视觉模拟评分(VAS)]、炎症指标[白介素6(IL-6)、D-二聚体(D-D)、C-反应蛋白(CRP)]、认知功能[简易智能精神状态量表(MMSE)]、血流动力学[心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)]及围术期不良反应。结果:术后12h、24h、48h,观察组与对照组VAS评分、定向力、记忆力、注意和计算力、回忆能力、语言能力和MMSE总分均有不同程度降低,IL-6、D-D、CRP、HR、SpO_(2)、MAP均有不同程度增高,但观察组各指标变化幅度小于对照组,两组均发生头晕、低血压、恶心呕吐、心动过缓等不同程度不良反应,围术期总不良反应观察组(20.0%)低于对照组(38.0%)(均P<0.05)。结论:Dex联合Rop行QLB对腹腔镜全子宫切除术患者术后有明显镇痛效果,可降低炎症反应,改善早期认知功能和血流动力学,降低不良反应。Objective: To investigate the effects of dexmedetomidine(Dex) combined with ropivacaine(Rop) for quadratus lumborum block(QLB) during laparoscopic total hysterectomy of patients on their postoperative analgesia, inflammation, early cognitive function and hemodynamics. Methods: 100 patients with uterine fibroids who wanted laparoscopic total hysterectomy in the hospital were included and were randomly divided into two groups(50 cases in each group) from January 2022 to May 2024. The patients in the control group were injected with 30mL 0.2% Rop in each side for QLB, and the patients in the observation group were injected with 0.50 μg/kg Dex and 30mL 0.2% Rop in each side. The analgesic effect evaluated by visual analogue scale(VAS), the levels of inflammatory indexes, such as interleukin-6(IL-6), D-dimer(D-D) and C-reactive protein(CRP), the cognitive function evaluated by mini-mental State examination(MMSE), the values of hemodynamics, such as heart rate(HR), blood oxygen saturation(SpO_(2)) and mean arterial pressure(MAP), of the patients before and after operation, and the perioperative adverse reactions rate of the patients were recorded and were compared between the two groups. Results: The VAS score, the directive force, the ability of memory, attention, calculation, recall, and language ability, and the MMSE total score of the patients in the two groups in the postoperative 12h, 24h and 48h had decreased to varying degrees, and the levels of IL-6,D-D and CRP,and the values of HR,SpO_(2)and MAP of the patients in the two groups in the postoperative 12h,24hand 48hhad increased to varying degrees,and the changes of which of the patients in the observation group were significantly less than those of the patients in the control group.There were patients with different degrees of the adverse reactions,such as dizziness,hypotension,nausea and vomiting,and bradycardia in the two groups.The total perioperative adverse reactions rate(20.0%)of the patients in the observation group were significantly lower than that(3

关 键 词：腹腔镜全子宫切除术 右美托咪定 罗哌卡因 腰方肌阻滞 术后镇痛 血流动力学 炎症反应 认知功能 不良反应 

分 类 号：R73[医药卫生—肿瘤]