星状神经节阻滞复合低浓度罗哌卡因硬膜外阻滞在卵巢癌根治术患者围术期镇痛效果  

Effect of stellate ganglion block combined with epidural block using low-concentration ropivacaine on perioperative analgesia in patients undergoing radical resection of ovarian cancer

作　　者：刘如玉 张盼盼 王文辉 付瑶 LIU Ru-yu;ZHANG Pan-pan;WANG Wen-hui;FU Yao(Department of Anesthesiology,the Third Hospital of Shandong Province,Jinan 250031,China;Department of Medical Imaging,Jidong Drug Rehabilitation Center,Shandong Province,Jinan 250031,China;Department of Anesthesiology,Shandong Clinical Center of Public Health,Jinan 250031,China)

机构地区：[1]山东省立第三医院麻醉科,山东济南250031 [2]山东省济东戒毒所影像科,山东济南250031 [3]山东省公共卫生临床中心麻醉科,山东济南250031

出　　处：《河北医科大学学报》2025年第3期342-348,共7页Journal of Hebei Medical University

基　　金：山东省自然科学技术项目(2021KJ0286)。

摘　　要：目的探讨星状神经节阻滞复合低浓度罗哌卡因硬膜外阻滞在卵巢癌根治术患者围术期镇痛效果。方法选择山东省立第三医院收治的卵巢癌患者118例,以随机数字表法将其分成研究组(59例)、对照组(59例)。所有患者均接受卵巢癌根治术,并给予全身静脉麻醉。对照组术前采用低浓度罗哌卡因硬膜外阻滞,研究组采用星状神经节阻滞复合低浓度罗哌卡因硬膜外阻滞(硬膜外阻滞前行星状神经节阻滞)。比较2组术后镇痛情况、视觉模拟评分法(visual analog scale,VAS)评分、血流动力学[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]、应激反应[皮质醇(cortisol,Cor)与促肾上腺皮质激素(adrenocorticotropin,ACTH)]、免疫功能[CD3+、CD4+、自然杀伤(natural killer,NK)]细胞及药物不良反应。结果研究组镇痛泵有效按压次数、补救镇痛率、舒芬太尼用量分别为(3.20±0.41)次、10.17%、(55.27±6.85)μg,低于对照组(P<0.05)。研究组术后2 h、术后24 h、术后48 h的VAS评分分别为(2.19±0.36)分、(1.43±0.29)分、(0.72±0.15)分,低于对照组(P<0.05)。研究组插管即刻(T1)、手术1 h时(T2)的HR、MAP分别为(80.10±6.18)次/min、(85.36±6.10)mmHg(1 mmHg=0.133 kPa),低于对照组(P<0.05)。研究组术后24 h的Cor、ACTH分别为(342.07±43.79)nmol/L、(16.29±3.74)ng/L,低于对照组(P<0.05)。研究组术后24 h的CD3+、CD4+、NK细胞分别为(53.27±5.12)%、(29.42±3.07)%、(21.18±3.16)%,高于对照组(P<0.05)。2组药物不良反应总发生率比较差异无统计学意义(P>0.05)。结论低浓度罗哌卡因硬膜外阻滞复合星状神经节阻滞用于卵巢癌根治术围术期镇痛效果确切,可减轻应激反应,改善术后短期免疫抑制,减少镇痛药物使用,维持术中血流动力学,且不会增加药物不良反应发生风险。Objective To investigate the perioperative analgesic effect of stellate ganglion block combined with epidural block using low-concentration ropivacaine in patients with ovarian cancer undergoing radical resection.Methods A total of 118 ovarian cancer patients admitted to the Third Hospital of Shandong Province were selected and divided into research group(n=59)and control group(n=59)by random number table method.All patients underwent radical resection of ovarian cancer and were given general intravenous anesthesia.The control group received epidural block using low-concentration ropivacaine before surgery,while the research group received stellate ganglion block combined with epidural block using low-concentration ropivacaine(planetary ganglion block before epidural block).Postoperative analgesia,visual analog scale(VAS)score,hemodynamics[heart rate(HR),mean arterial pressure(MAP)],stress response[cortisol(Cor)and adrenocorticotropin(ACTH)],immune function[CD3+,CD4+,natural killer cells(NK)],and adverse drug reactions were compared between the two groups.Results The number of effective analgesic pump,the rate of relief analgesia and the dosage of sufentanil in the research group were(3.20±0.41)times,10.17%and(55.27±6.85)μg,respectively,which were lower than those in the control group(P<0.05).The VAS scores of the research group were(2.19±0.36),(1.43±0.29)and(0.72±0.15)at 2 h,24 h and 48 h after surgery,respectively,which were lower than those in the control group(P<0.05).HR and MAP of the research group were(80.10±6.18)times/min and(85.36±6.10)mmHg(1 mmHg=0.133 kPa)respectively immediately after intubation(T1)and at 1 h(T2)after initiation of surgery,which were lower than those in thecontrol group(P<0.05).The Cor and ACTH of the research group at 24 h after surgery were(342.07±43.79)nmol/L and(16.29±3.74)ng/L,respectively,which were lower than those in the control group(P<0.05).The CD3+,CD4+and NK cells in the research group were(53.27±5.12)%,(29.42±3.07)%and(21.18±3.16)%,respectively,which were hig

关 键 词：卵巢肿瘤 星状神经节阻滞 罗哌卡因 硬膜外阻滞 

分 类 号：R737.71[医药卫生—肿瘤]