罗哌卡因混合右美托咪定胸椎旁阻滞对肾切除术患者炎症反应的影响

Effect of ropivacaine combined with dexmedetomidine in thoracic paravertebral block on inflammatory response in patients undergoing nephrectomy

目的研究罗哌卡因混合右美托咪定胸椎旁神经阻滞(TPVB)对腹腔镜肾切除术患者炎症反应的影响,评价胸椎旁神经阻滞联合全麻在腹腔镜肾切除术中的效果。方法选择河南省人民医院2018年1月—2019年6月择期行腹腔镜肾切除术患者60例,将患者随机分为2组:单纯全麻组(G组)、TPVB联合全麻组(T组)。记录术前(T0)、手术结束时(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)的血流动力学和采集静脉血样,检测血浆中IL-6、CRP的浓度。记录术中丙泊酚和瑞芬太尼用量,手术时间,PACU停留时间,术后VAS评分和不良事件等的发生情况。结果与G组比较,T组丙泊酚和瑞芬太尼用量减少(P<0.05);术中高血压、心动过速发生率降低(P<0.05);T组T3-6时点VAS评分降低(P<0.05);T组T1-5各时点IL-6、CRP浓度降低(P<0.05)。结论罗哌卡因混合右美托咪定胸椎旁神经阻滞可减轻腹腔镜肾切除术患者炎症反应。

Objective To study the effect of ropivacaine combined with dexmedetomidine paravertebral nerve block(TPVB)on inflammatory response in patients undergoing laparoscopic nephrectomy,and to evaluate the effect of paravertebral nerve block combined with general anesthesia in laparoscopic nephrectomy.Methods Totally 60 patients with laparoscopic nephrectomy were randomly divided into two groups:general anesthesia group(G group)and TPVB combined general anesthesia group(T group).Hemodynamics before the surgery(T0),at the end of surgery(T1),and at 6h(T2),12h(T3),24 h(T4),and 48h(T5)after surgery were recorded and venous blood samples were collected to detect plasma concentrations of IL-6 and CRP.The intraoperative dosage of propofol and remifentanil,operative time,PACU residence time,postoperative VAS score and adverse events were recorded.Results Compared with G group,the dosage of propofol and remifentanil in T group were reduced(P<0.05).The incidence of hypertension and tachycardia decreased during operation(P<0.05).The VAS scores of T group were decreased at T3-6(P<0.05).IL-6 and CRP concentrations decreased at each time of T1-5 in the T group(P<0.05).Conclusion Ropivacaine combined with dexmedetomidine in thoracic paravertebral nerve block can reduce the inflammatory response in patients undergoing laparoscopic nephrectomy.