依托咪酯联合腹横筋膜平面阻滞对腹腔镜全子宫切除术患者血流动力学、术后炎症指标及认知的影响  

Effects of etomidate combined with transverse fascia plane block used during laparoscopic total hysterectomy of patients on their hemodynamics,postoperative inflammatory indexes and cognitive status

作　　者：陶晓薇 刘艳 肖敏 TAO Xiaowei;LIU Yan;XIAO Min(Shanghai Anting Hospital,Jiading District,Shanghai,201805)

机构地区：[1]上海市嘉定区安亭医院,201805

出　　处：《中国计划生育学杂志》2025年第4期799-804,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨依托咪酯联合腹横筋膜平面阻滞(TFPB)应用于腹腔镜全子宫切除术(LTH)效果。方法:选取2022年5月-2024年5月本院拟行LTH患者150例,随机数字表法分为两组各75例。均采用全身麻醉联合TFPB,观察组实施丙泊酚复合依托咪酯行麻醉维持,对照组采用丙泊酚麻醉维持。比较两组各时点血流动力学[心率(HR)、平均动脉压(MAP)],术前1 d、术后1 d及3 d简易智力状态检查量表(MMSE)评分、血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β蛋白)及炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]变化,并统计两组不良反应率。结果:两组不同时点HR、MAP比较无差异(P>0.05)。术后1 d、3 d观察组MMSE评分(26.57±1.06分、27.11±1.32分)均高于对照组(25.04±1.12分、26.17±1.21分),血清NSE(8.12±1.05、7.25±1.06)μg/L、S100β(0.45±0.09、0.35±0.08)μg/L水平低于对照组,血清TNF-α(12.25±1.78、8.52±1.19 ng/L)、IL-6(48.62±12.35、29.15±8.45)ng/L、IL-1β(7.62±1.13、4.31±0.82)ng/L水平均低于对照组(均P<0.05),不良反应发生率(16.0%)与对照组(10.7%)无差异(P>0.05)。结论:依托咪酯联合TFPB可减轻LTH患者术后神经损伤与认知功能损害,可能与降低炎症反应有关,且血流动力学稳定,安全性良好。Objective:To investigate the effect of etomidate combined with transverse abdominal fascial plane block(TFPB)used during laparoscopic total hysterectomy(LTH)of patients.Methods:A total of 150 patients who wanted LTH in the hospital were selected and were divided into two groups(75 patients in each group)by random number table method from May 2022 to May 2024.All the enrolled patients received the general anesthesia combined with TFPB during LTH.The patients in the observation group were treated with propofol combined with etomidate for anesthetic maintenance,while the patients in the control group were treated with propofol alone for anesthetic maintenance.The values of the hemodynamics,such as heart rate(HR)and mean arterial pressure(MAP)at different time points,the score of simple mental state examination scale(MMSE)in 1 day before surgery,in the 1st d and the 3rd day after surgerynd,and the level changes of the serum neuron-specific enolase(NSE),S100 calc-binding proteinβ(S100β),and the inflammatory factors,such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-1β(IL-1),of the patients were compared between the two groups.The adverse reaction rate of the patients in the two groups was calculated.Results:There was no significant difference in the values of HR and MAP of the patients at different time points between the two groups(P>0.05).The MMSE score of the patients in the observation group in the 1st day or in the 3rd day after operation(26.57±1.06 points or 27.11±1.32 points)was significantly higher than that(25.04±1.12 points or 26.17±1.21 points)of the patients in the control group.The levels of serum NSE(8.12±1.05μg/L or 7.25±1.06μg/L)and S100β(0.45±0.09μg/L or 0.35±0.08μg/L)of the patients the observation group in 1st day or the 3rd day after operation were significantly lower than those of the patients in the control group.The serum levels of TNF-α(12.25±1.78ng/L or 8.52±1.19ng/L),IL-6(48.62±12.35ng/L or 29.15±8.45ng/L)and IL-1β(7.62±1.13ng/L or 4.31±0.82ng/

关 键 词：腹腔镜全子宫切除术 依托咪酯 腹横筋膜平面阻滞 麻醉维持 认知功能 炎症因子 不良反应 

分 类 号：R614[医药卫生—麻醉学]