小剂量氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对肛肠手术患者术中应激反应的影响

Effect of low dose ketamine intravenous general anesthesia combined with ropivacaine sacral canal block on intraoperative stress response in patients undergoing anorectal surgery

目的研究小剂量氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对肛肠手术患者术中应激反应的影响。方法选取2019年1月~2020年5月期间接收的110例肛肠手术患者为研究对象,按麻醉方案划分为观察组(n=55)与对照组(n=55)。对照组予以氯胺酮静脉全身麻醉方案,观察组予以小剂量氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞方案,对两组患者手术不同时间点应激反应、血流动力学指标、感觉阻滞起效及持续时间、苏醒时间、认知功能变化及不良反应发生情况进行比较分析。结果T_(1)、T_(2)、T_(3)、T_(4)时两组患者HR、MAP对比无显著差异(P>0.05)。T_(1)时两组患者皮质醇、IL-6水平对比差异不明显(P>0.05),T_(2)、T_(3)、T_(4)时观察组皮质醇、IL-6水平均比对照组低(P<0.05)。观察组感觉阻滞起效时间、苏醒时间比对照组短,感觉持续时间比对照组长(P<0.05)。观察组不良反应发生率比对照组低(P<0.05)。结论对于肛肠手术患者采用小剂量氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞有助于减轻机体应激反应,提高麻醉安全有效性,减少术后不良反应发生情况。

Objective To study the effect of low-dose ketamine intravenous general anesthesia combined with ropivacaine sacral canal block on intraoperative stress response in patients undergoing anorectal surgery.Methods A total of 110 patients undergoing anorectal surgery received from January 2019 to May 2020 were selected as the research objects,and were divided into the observation group(n=55)and the control group(n=55)according to the anesthesia plan.The control group was given ketamine intravenous general anesthesia,and the observation group was given low-dose ketamine intravenous general anesthesia combined with ropivacaine sacral block.Comparative analysis of onset and duration,wake-up time,changes in cognitive function and occurrence of adverse reactions.Results There was no significant difference in HR and MAP between the two groups at T_(1),T_(2),T_(3),and T_(4)(P>0.05).There was no significant difference in the levels of cortisol and IL-6 between the two groups at T_(1)(P>0.05).At T_(2),T_(3),and T_(4),the levels of cortisol and IL-6 in the observation group were lower than those in the control group(P<0.05).The onset time and wake-up time of sensory block in the observation group were shorter than those in the control group,and the sensory duration was longer than that in the control group(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion For patients undergoing anorectal surgery,the use of low-dose ketamine intravenous general anesthesia combined with ropivacaine sacral block can help reduce the body's stress response,improve the safety and effectiveness of anesthesia,and reduce the occurrence of postoperative adverse reactions.