右美托咪定联合腹横肌平面阻滞对腹腔镜结直肠手术患者术后胃肠道功能的影响

Effect of dexmedetomidine combined with transverse abdominal plane block on gastrointestinal function in patients undergoing laparoscopic colorectal surgery

目的探讨右美托咪定联合腹横肌平面阻滞(TAPB)对腹腔镜结直肠手术患者术后胃肠道功能的影响。方法选取择期行腹腔镜结直肠手术的患者82例,随机分为右美托咪定+TAPB(研究组)和生理盐水(对照组),每组41例。观察两组术后不同时间点I-FEED评分、术后胃肠道功能障碍(POGD)发生情况、炎性因子水平及康复指标。结果 (1)研究组患者术后24、48、72和96 h的I-FEED评分均低于对照组(P <0.05);(2)研究组患者POGD发生率、术后恶心呕吐发生率分别为7.32%、19.51%,对照组患者POGD发生率、术后恶心呕吐分别为34.15%、48.78%,组间比较差异有统计学意义(P <0.05);(3)研究组患者术中瑞芬太尼泵注用量,术后24、48、72 h的VAS评分和术后镇痛泵按压次数均小于对照组(P <0.05);(4)研究组患者首次排便时间、首次经口进食时间及首次下床活动时间均明显短于对照组(P <0.05);(5)两组治疗后1 d研究组患者CRP、TNF-α及治疗后3 d IL-1β水平明显低于对照组(P <0.05)。结论腹腔镜结直肠手术患者采取右美托咪定联合TAPB,可加快患者康复进程,为腹腔镜结直肠手术患者POGD防治提供有效策略。

Objective To investigate the effect of dexemetomidine combined with transverse abdominal plane block(TAPB) on postoperative gastrointestinal function in patients with laparoscopic colorectal surgery.Methods Eighty-two patients with selected laparoscopic colorectal surgery were randomly divided into DM + TAPB(study group)and saline(control group)in equal number. I-FEED scores at different postoperative time points,postoperative gastrointestinal dysfunction(POGD)occurrence,inflammatory factor level and recovery indicators were observed and compared between the two groups. Results(1)The I-FEED scores of the study group were lower than those of the control group at 24,48,72 and 96 h,respectively(P < 0.05).(2)The incidences of POGD and PONV in the study group significantly lower than those of the control group,respectively(7.32% vs. 34.15%;19.51%vs. 48.78%,P < 0.05).(3)The dose of intraoperative refentanyl by pump injection in the study group,the VAS scores and the number of postoperative analgesic compressions at 24,48 and 72 h were significantly smaller than in the control group(P < 0.05).(4)The time of first defecation time,first oral feeding and first off-bed activity of the study group was significantly shorter than that of the control group(P < 0.05).(5)The levels of CRP,TNF-α in 1 d I and3 d IL-1β after treatment were significantly lower after treatment than in the control group(P < 0.05). Conclusion Dexemetomidine combined with TAPB can effectively prevent the occurrence of POGD in patients having undergone laparoscopic colorectal surgery,accelerate their recovery,and provide effective strategies for POGD treatment.