不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜腹股沟疝修补术患者应激反应的影响

Effects of Different Doses of Dexmedetomidine Combined with Ropivacaine Transversus Abdominis Plane Block on Stress Response in Patients with Laparoscopic Inguinal Hernia Repair

目的:探讨不同剂量右美托咪定(DEX)复合罗哌卡因腹横肌平面(TAP)阻滞对腹腔镜腹股沟疝修补术患者应激反应的影响。方法:选择2020年1月—2020年9月本院收治的拟在全麻下行腹腔镜腹股沟疝修补术患者80例,采用随机数字表法分为四组,分别为罗哌卡因组(R组)和罗哌卡因复合DEX组(D1-3组),每组各20例。四组患者于麻醉诱导前行超声引导下双侧TAP阻滞,给予R组0.25%罗哌卡因,每侧20 mL;给予D1组0.5μg/kg DEX+0.25%罗哌卡因,D2组1μg/kg DEX+0.25%罗哌卡因,D3组1.5μg/kg DEX+0.25%罗哌卡因,每侧皆为20 mL。比较四组不同时间血流动力学[包括TAP阻滞前(T1)、气腹前(T2)、气腹后0.5h(T3)、气管拔管后10 min(T4)时平均动脉压(MAP)及心率(HR)]、应激反应[包括T1-T4各时间点血清白细胞介素-6(IL-6)、皮质醇(Cor)以及血糖(Glu)水平]、术中不良反应发生率(包括高血压、低血压、心动过速、心动过缓等)。结果:R组T2时MAP水平较T1时上升,D3组T2、T3、T4时MAP、HR水平较T1时下降,差异有统计学意义(P<0.05);R组、D1组、D2组T1、T2、T3、T4时HR水平比较,差异无统计学意义(P>0.05);与R组比较,D1、D2、D3三组间在T2、T3、T4时血清IL-6、Cor及Glu水平比较,差异有统计学意义(P<0.05);R组在T2、T3、T4时的血清IL-6、Cor及Glu水平高于T1时,D2、D3两组在T2、T3、T4时的血清IL-6、Cor及血Glu水平低于D1组,差异有统计学意义(P<0.05);R组术中高血压及心动过速发生率最高,D3组术中低血压及心动过缓发生率最高,与其他各组比较差异有统计学意义(P<0.05)。结论:1μg/kg DEX复合罗哌卡因TAP阻滞可有效减轻腹腔镜腹股沟疝修补术患者围术期应激反应,稳定血流动力学,且安全性较好。

Objective:To investigate the effect of different doses of dexmedetomidine(DEX)combined with ropivacaine transversus abdominis plane block(TAP)on stress response in patients with laparoscopic inguinal hernia repair.Methods:80 patients treated and planned to undergo laparoscopic inguinal hernia repair under general anesthesia in our hospital from January 2020 to September 2020 were selected.According to random number table method,they were divided into 4 groups,namely a ropivacaine group(R group)and a ropivacaine combined with DEX group(D1-3 groups),with 20 cases in each group.4 groups all underwent ultrasound-guided bilateral TAP block before induction of anesthesia.R group was given 0.25%ropivacaine,with 20 mL on each side;D1 group was given 0.5μg/kg DEX+0.25%ropivacaine,D2 group 1μg/kg DEX+0.25%ropivacaine,D3 group 1.5μg/kg DEX+0.25%ropivacaine,each side was 20mL.The hemodynamics[including the mean arterial pressure(MAP)and heart rate(HR)before TAP block(T1),before pneumoperitoneum(T2),0.5 h after pneumoperitoneum(T3),and 10 minutes after tracheal extubation(T4)],stress response[including serum interleukin-6(IL-6),cortisol(Cor)and blood glucose(Glu)levels at each time point of T1-T4],incidence of intraoperative adverse reactions[including hypertension,hypotension,tachycardia,bradycardia,etc.]of the four groups at different times were compared.Results:The MAP levels at T2 in group R was increased compared with those at T1,the MAP and HR levels at T2,T3,and T4 in the group D3 were decreased compared with those at T1,with statistical significant differences(P<0.05);compared HR levels at T1,T2,T3,and T4 in groups R,D1,and D2,the difference was not statistically significant(P>0.05);compared with the group R,compared the serum IL-6,Cor and Glu levels at T2,T3,and T4 in groups D1,D2,and D3,the difference was significant statistically(P<0.05);the serum IL-6,Cor and Glu levels of group R at T2,T3,and T4 were higher than those at T1,the serum IL-6,Cor and blood Glu levels of groups D2 and D3 at T2,T3,and T4 were lower than those of the D1 group,with statistical significant differences(P<0.05);the incidence of hypertension and tachycardia was the highest in group R,the incidence of intraoperative hypotension and bradycardia was the highest in group D3,with statistical significant differences(P<0.05).Conclusion:1μg/kg DEX combined with ropivacaine TAP block can effectively reduce the perioperative stress response of patients with laparoscopic inguinal hernia repair,stabilize hemodynamics,and has good safety.