布托啡诺联合腹横肌平面阻滞在老年腹腔镜手术患者中的应用效果

Effect of Butorphanol combined with transversus abdominis plane blockade in elderly patients undergoing laparoscopic surgery

目的分析布托啡诺联合腹横肌平面阻滞在老年腹腔镜手术患者中的应用效果。方法选择2020年6月至2021年2月温州医科大学附属东阳医院拟行腹腔镜手术的老年患者160例,采用随机数字表法分为对照组80例与观察组80例。对照组采用腹横肌平面阻滞,观察组采用布托啡诺(麻醉诱导给予0.20μg/kg,缝皮前30 min给予0.10μg/kg)联合腹横肌平面阻滞,比较两组应用效果。结果对照组手术不同时间的心率、收缩压、舒张压及平均动脉压差异均有统计学意义(均P<0.05),观察组上述指标差异均无统计学意义(均P>0.05)。观察组患者术后首次镇痛泵按压时间长于对照组[(12.8±3.9)h比(9.4±3.2)h],术后24 h内镇痛泵按压次数少于对照组[(1.0±0.4)次比(1.9±0.6)次],差异均有统计学意义(均P<0.05)。观察组术后8、12、24 h的疼痛评分低于对照组[(2.1±1.0)分比(3.2±1.2)分、(3.6±0.7)分比(4.5±1.1)分、(3.8±0.8)比(4.6±1.0)分],差异均有统计学意义(均P<0.05)。两组术后皮质醇、肿瘤坏死因子α(TNF-α)及白细胞介素6(IL-6)水平逐渐增高,但观察组增高幅度明显低于对照组,差异均有统计学意义(均P<0.05)。结论布托啡诺联合腹横肌平面阻滞能够减少老年腹腔镜手术患者的心率及血压波动,改善术后镇痛效果,还有助于减轻手术应激、稳定机体免疫。

Objective To analyze of the effect of Butorphanol combined with transversus abdominis plane blockade in elderly patients undergoing laparoscopic surgery.Methods We selected 160 elderly patients underging laparoscopic surgery in Dongyang Hospital Affiliated to Wenzhou Medical University from June,2020 to February 2021.Patiens were divided into 80cases in the control group and 80 cases in the observation group using the random number table method.Transversus abdominis plane blockade was used in the control group,while Butorphanol(administer 0.20μg/kg for induction of anesthesia,administer 0.10μg/kg 30 minutes before skin suture)combined with transversus abdominis plane blockade was used in the observation group.We compared the application effect of the two groups.Results The differences in heart rate,systolic blood pressure,diastolic blood pressure and mean arterial pressure in the control group at different times of surgery were statistically significant(all P<0.05),while the above indexes in the observation group were not statistically significant(all P>0.05).In the observation group,the time to first postoperative analgesic pump press was longer than that in the control group[(12.8±3.9)h vs.(9.4±3.2)h],and the number of postoperative analgesic pump press was less than that in the control group within 24hours[(1.0±0.4)times vs.(1.9±0.6)times].The differences were statistically significant(all P<0.05).The pain scores at8,12 and 24 h postoperatively in the observation group were statistically lower than those in the control group[(2.1±1.0)points vs.(3.2±1.2)points,(3.6±0.7)points vs.(4.5±1.1)points,(3.8±0.8)points vs.(4.6±1.0)points,all P<0.05].The levels of cortisol,tumor necrosis factorα(TNF-α)and interleukin 6(IL-6)gradually increased after surgery in both groups,but the increase in the observation group was significantly lower than that in the control group,and the difference was statistically significant(all P<0.05).Conclusion Butorphanol combined with transversus abdominis plane blockade can reduce the fluctuation of heart rate and blood pressure in elderly patients undergoing laparoscopic surgery,improve the postoperative analgesic effect,as well as help reduce surgical stress and stabilize the body immunity.