右美托咪定联合不同浓度罗哌卡因局部神经阻滞在老年腹股沟疝无张力修补术中的应用

Application of dexmedetomidine combined with different concentrations of ropivacaine local nerve block in tension-free inguinal hernia repair in elderly patients

目的分析右美托咪定联合不同浓度罗哌卡因局部神经阻滞在老年腹股沟疝无张力修补术中的应用。方法2020年3月至2022年3月内蒙古包钢医院收治的老年腹股沟疝患者80例,采用随机数字表法分为A组与B组,各40例。2组均接受无张力疝修补术治疗,A组接受0.1%罗哌卡因局部神经阻滞联合右美托咪定静脉泵入麻醉,B组采用0.2%罗哌卡因局部神经阻滞联合右美托咪定静脉泵入麻醉,术后均观察7 d。分析2组不同时间点生命体征,术后2 h、24 h疼痛、镇静、运动及认知评分,术前、术后7 d 2组血清Tau蛋白、β-淀粉样蛋白多肽42(Aβ42)蛋白以及Tau/Aβ42水平,术后24 h不良反应发生情况。结果切皮时(T2)B组心率低于入室(T0)、阻滞后15 min(T1)及手术结束时(T3),且低于A组(P<0.05),其余时刻心率、平均动脉压、脉搏血氧饱和度比较,差异无统计学意义(P>0.05)。与术后2 h比较,术后24 h 2组视觉模拟评分(VAS)、Bromage评分均降低,且A组VAS评分在2组中更低(P<0.05);术后24 h 2组简易智力状态检查量表(MMSE)评分均升高,且A组在2组中更高(P<0.05)。与术前比较,术后7 d 2组血清Tau蛋白、Tau/Aβ42水平均升高,但A组较B组更低;术后7 d 2组血清Aβ42蛋白降低,但A组较B组更高(P<0.05)。术后24 h,A组不良反应发生率较B组更低(7.50%vs27.50%,P<0.05)。结论0.1%罗哌卡因局部神经阻滞联合右美托咪定静脉泵入麻醉可稳定老年腹股沟疝无张力修补术患者生命体征,缓解疼痛,改善患者认知功能,安全性更高,分析与其调节Tau蛋白、Aβ42蛋白水平有关,值得临床进一步研究。

Objective To analyze the application of dexmedetomidine combined with different concentrations of ropivacaine local nerve block in tension-free repair in inguinal hernia in elderly patients.Methods Eighty elderly patients with inguinal hernia admitted to Baogang Hospital of Inner Mongolia from March 2020 to March 2022 were divided into group A and group B,with 40 cases in each group.The method was the random number table method.Group A received 0.1%ropivacaine local nerve block combined with dexmedetomidine intravenous pump anesthesia,and group B received 0.2%ropivacaine local nerve block combined with dexmedetomidine intravenous pump anesthesia.All patients were observed for 7 days after the operation.The vital signs at different time points,pain,sedation,exercise and cognition scores 2h and 24h after operation,serum levels of Tau protein,beta amyloid polypeptide 42(Aβ42)protein and Tau/Aβ42 before and 7 d after the operation,and the occurrence of adverse reactions 24h after operation of the two groups were analyzed.Results The heart rate of the group B at skin incision(T2)was lower than that of room entry(T0),15 minutes after block(T1)and at the end of operation(T3),and lower than that of the group A(P<0.05),HR at other times,mean arterial pressure,pulse oxygen saturation of the two groups was not statistically significant(P>0.05).Compared with 2h after operation,the scores of visual analogue scale(VAS)and Bromage in the two groups decreased at 24 h after operation,and the score of VAS in group A was lower in the two groups(P<0.05).The score of mini-mental state examination(MMSE)was elevated at 24 h after operation,and the score of group A was higher in both groups(P<0.05).Compared with preoperative,serum levels of Tau protein and Tau/Aβ42 in both groups increased at 7 d after operation,and were lower in group A;Aβ42 protein decreased in both groups at 7d after operation and was higher in group A(P<0.05).At 24h after operation,the incidence of adverse reactions in the group A was lower(7.50%vs27.50%,P<0.05).Conclusion 0.1%ropivacaine local nerve block combined with dexmedetomidine intravenous pump anesthesia can stabilize vital signs,relieve pain,and improve cognitive function of elderly patients with tension-free inguinal hernia repair and has higher safety.Analysis of its relationship with regulating Tau protein and Aβ42 protein levels is worthy of further clinical research and application.