[1]郭 聪,杨 昊.罗哌卡因复合不同剂量右美托咪定腹横肌平面阻滞对胃肠道腹腔镜手术患者镇痛及术后认知功能的影响[J].陕西医学杂志,2021,50(8):1011-1014.[doi:DOI:10.3969/j.issn.1000-7377.2021.08.027]
　GUO Cong,YANG Hao.Effect of ropivacaine combined with different doses of dexmedetomidine in transversus abdominis plane block on intraoperative analgesia and the incidence of postoperative cognitive dysfunction in gastrointestinal laparoscopic surgery[J].,2021,50(8):1011-1014.[doi:DOI:10.3969/j.issn.1000-7377.2021.08.027]
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罗哌卡因复合不同剂量右美托咪定腹横肌平面阻滞对胃肠道腹腔镜手术患者镇痛及术后认知功能的影响
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年8期
页码:
1011-1014
栏目:
药物与临床
出版日期:
2021-08-05

文章信息/Info

Title:
Effect of ropivacaine combined with different doses of dexmedetomidine in transversus abdominis plane block on intraoperative analgesia and the incidence of postoperative cognitive dysfunction in gastrointestinal laparoscopic surgery
作者:
郭 聪; 杨 昊
(汉中市人民医院手术麻醉科,陕西 汉中 723000)
Author(s):
GUO Cong; YANG Hao
(Department of Surgical Anesthesiology,Hanzhong People's Hospital,Hanzhong 723000,China)
关键词:
罗哌卡因;  右美托咪定;  腹横肌平面阻滞;  应激反应;  术后认知功能障碍
Keywords:
Ropivacaine;  Dexmedetomidine;  Transversus abdominis plane block;  Stress response;  Postoperative cognitive dysfunction
分类号:
R 614.4
DOI:
DOI:10.3969/j.issn.1000-7377.2021.08.027
文献标志码:
A
摘要:
目的:观察罗哌卡因复合不同剂量右美托咪定腹横肌平面阻滞(TAPB)对胃肠道腹腔镜手术患者镇痛及术后认知功能障碍(POCD)发生率的影响。方法:选择实施胃肠道腹腔镜手术的患者120例,随机分为两组,对照组60例,术前给以罗哌卡因配合右美托咪定(0.75 μg/kg)实施TAPB,观察组60例,术前给以罗哌卡因配合右美托咪定(1.0 μg/kg)实施TAPB; 术毕两组均接受右美托咪定(2.0 μg/kg)配合罗哌卡因持续镇痛至术后48 h。记录两组手术不同时间(术后6、12、24、48 h)的疼痛视觉模拟量表(VAS)评分和Ramsay镇静量表评分(RSS); 比较两组术前、术后6、12、24 h的血浆C-反应蛋白(CRP)和血糖(Glu); 记录术前1 d、术后1、3、5 d的蒙特利尔认知评估量表(MoCA)和简易智力测评量表(MMSE)评分; 并记录术后1、3、5、7 d的POCD发生率。结果:①观察组术后6、12、24、48 h的VAS评分低于对照组,RSS评分高于对照组,差异均有统计学意义(均P<0.05); ②与术前比较,两组术后6、12、24 h的血浆CRP和Glu水平均显著增高,差异均有统计学意义(均P<0.05),观察组在上述时间点的以上指标均低于对照组,差异均有统计学意义(均P<0.05); ③观察组在术后1、3、5 d的MoCA和MMSE评分均高于对照组,差异有统计学意义(均P<0.05); ④观察组术后1、3、5 d的POCD发生率和总发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论:与术前给以罗哌卡因配合低剂量右美托咪定(0.75 μg/kg)实施TAPB相比较,罗哌卡因与高剂量右美托咪定(1.0 μg/kg)实施TAPB对胃肠道腹腔镜手术中的镇痛与镇静疗效更佳,且能够降低围术期应激反应,降低POCD发生率。
Abstract:
Objective:To observe the effect of ropivacaine combined with different doses of dexmedetomidine in transversus abdominis plane block(TAPB)on intraoperative analgesia and the incidence of postoperative cognitive dysfunction(POCD)in gastrointestinal laparoscopic surgery.Methods:120 patients undergoing gastrointestinal laparoscopic surgery were selected and randomly divided into two groups.60 patients in the control group were given ropivacaine combined with dexmedetomidine(0.75 μg/kg),and 60 patients in the observation group were given ropivacaine combined with dexmedetomidine(1.0 μg/kg)for TAPB before operation,and patients in both groups were given dexmedetomidine(2.0 μg/kg)combined with ropivacaine for continuous analgesia until 48 hours after operation.VAS score and RSS score were recorded at different time points(6,12,24,48 hours)after operation.The plasma CRP and Glu were compared before operation and 6,12,24 hours after operation between the two groups.MoCA and MMSE scores were recorded at 1 day before operation and 1,3,5 days after operation.The incidence of POCD at 1,3,5 and 7 days after operation was recorded.Results:The VAS score of the observation group at 6,12,24 and 48 hours after operation was lower than that of the control group,and the RSS score of the observation group was higher than that of the control group(all P<0.05).The plasma CRP and Glu levels at 6,12 and 24 hours after operation in the two groups were significantly higher than those before operation(all P<0.05),and the above indexes in the observation group at the above time points were lower than those in the control group(all P<0.05).The MOCA and MMSE scores of the observation group at 1,3 and 5 days after operation were higher than those of the control group(all P<0.05).The incidence and the total incidence of POCD in the observation group at 1,3 and 5 days after operation were lower than those in the control group(all P<0.05).Conclusion:Compared with preoperative administration of ropivacaine combined with low-dose dexmedetomidine(0.75 μg/kg)for TAPB,ropivacaine and high-dose dexmedetomidine(1.0 μg/kg)for TAPB have better analgesic and sedative effects in gastrointestinal laparoscopic surgery,and can reduce perioperative stress response and the incidence of POCD.

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更新日期/Last Update: 2021-08-05