右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜结直肠手术患者快速康复的影响研究

Study on effect of dexmedetomidine combined with ropivacaine for transversus abdominis plane block on rapid recovery of patients undergoing laparoscopic colorectal surgery

目的 探讨右美托咪定复合罗哌卡因腹横肌平面阻滞(TAPB)对腹腔镜结直肠手术患者快速康复的影响。方法 60例腹腔镜结直肠手术患者,按随机数字表法分为A组、B组及C组,各20例。A组采用全身麻醉,B组采用罗哌卡因腹横肌平面阻滞,C组采用右美托咪定复合罗哌卡因腹横肌平面阻滞。比较三组患者各时间段[拔管后即刻(T1)及术后6 h(T2)、12 h(T3)、24 h(T4)、36 h(T5)、48 h(T6)]视觉模拟评分法评分,术后相关指标,不良反应发生情况及手术前后炎性指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)]。结果 T2、T3、T4,B组患者视觉模拟评分法评分均低于A组,差异有统计学意义(P<0.05);T2、T3、T4、T5,C组患者视觉模拟评分法评分均低于A组,差异有统计学意义(P<0.05)。C组患者术后首次排气时间(1.5±0.7)d、首次排便时间(2.7±0.9)d和住院时间(7.6±0.4)d均短于A组的(2.9±0.6)、(4.2±0.6)、(10.2±0.6)d和B组的(2.2±0.6)、(3.7±0.7)、(9.3±0.7)d,舒芬太尼使用剂量(81.5±3.1)μg明显少于A组的(122.7±6.2)μg和B组的(101.8±5.2)μg,差异有统计学意义(P<0.05)。术后24 h,C组患者IL-6(36.7±1.6)ng/L、CRP(8.1±0.9)mg/L明显低于A组的(65.2±2.2)ng/L、(18.0±0.7)mg/L和B组的(51.3±1.8)ng/L、(14.1±0.5)mg/L,差异有统计学意义(P<0.05)。C组患者不良反应发生率5.0%明显低于A组的30.0%和B组的35.0%,差异有统计学意义(P<0.05)。结论 右美托咪定复合罗哌卡因腹横肌平面阻滞在腹腔镜结直肠手术快速康复外科中应用,可改善术后镇痛效果,减轻机体的应激反应,减少胃肠道不良反应,缩短住院时间,有利于患者术后快速康复,值得临床推广。

Objective To discuss the effect of dexmedetomidine combined with ropivacaine for transversus abdominis plane block(TAPB)on rapid recovery of patients with laparoscopic colorectal cancer surgery.Methods A total of 60 patients undergoing laparoscopic colorectal surgery were divided into group A,group B and group C according to the random numerical table,with 20 patients in each group.Group A received general anesthesia,group B received ropivacaine transversus abdominis plane block,and group C received dexmedetomidine combined with ropivacaine transversus abdominis plane block.Patients in three groups were compared in terms of visual analogue scale score at different time periods[immediately after extubation(T1)and 6 h after surgery(T2),12 h after surgery(T3),24 h after surgery(T4),36 h after surgery(T5),48 h after surgery(T6)],postoperative related indicators,occurrence of adverse reactions,and inflammatory indicators[interleukin-6(IL-6),C-reactive protein(CPR)]before and after surgery.Results At T2,T3,T4,the visual analogue scale scores in group B were lower than those in group A,and the differences were statistically significant(P<0.05).At T2,T3,T4,T5,the visual analogue scale scores in group C were lower than those in group A,and the differences were statistically significant(P<0.05).In group C,the first postoperative exhaust time was(1.5±0.7)d,the first defecation time was(2.7±0.9)d and the length of hospital stay was(7.6±0.4)d,which were all shorter than those of group A[(2.9±0.6),(4.2±0.6)and(10.2±0.6)d]and group B[(2.2±0.6),(3.7±0.7)and(9.3±0.7)d];the dosage of sufentanil of(81.5±3.1)μg in group C was significantly lower than that in group A[(122.7±6.2)μg]and group B[(101.8±5.2)μg];the differences were statistically significant(P<0.05).24 h after surgery,IL-6 of(36.7±1.6)ng/L and CRP of(8.1±0.9)mg/L in group C were significantly lower than those in group A[(65.2±2.2)ng/L and(18.0±0.7)mg/L]and group B[(51.3±1.8)ng/L and(14.1±0.5)mg/L],and the differences were statistically significant(P<0.05).The incidence of adverse drug reactions in group C(5.0%)was significantly lower than that in group A(30.0%)and group B(35.0%),and the difference was statistically significant(P<0.05).Conclusion The application of dexmedetomidine combined with ropivacaine transversus abdominis plane block in fast track surgery of laparoscopic colorectal surgery can improve the postoperative analgesic effect,reduce the stress response of the body,reduce gastrointestinal adverse reactions,shorten the length of hospital stay,which is conducive to the rapid postoperative recovery of patients,and is worthy of clinical promotion.