超声引导下右美托咪定复合罗哌卡因腹横肌平面阻滞在结肠癌腹腔镜手术中的应用效果

Effect of ultrasound-guided dexmedetomidine combined with ropivacaine transversal plane block in laparoscopic surgery for colon cancer

目的探讨超声引导下右美托咪定复合罗哌卡因腹横肌平面阻滞在结肠癌腹腔镜手术中的应用效果。方法选取2019年12月至2020年12月于本院行腹腔镜结肠癌根治术的89例患者作为研究对象,根据就诊顺序编号分为观察组(n=45,就诊顺序为奇数)与对照组(n=44,就诊顺序为偶数)。两组术前均采用相同麻醉诱导,对照组在麻醉诱导完成后于超声引导下采用罗哌卡因腹横肌平面阻滞,观察组在对照组基础上增加右美托咪定,比较两组围术期应激反应指标[血糖(Glu)、皮质醇(Cor)、去甲肾上腺素(NE)]、术后各时间点疼痛程度及不良反应发生情况。结果两组Glu、Cor及NE水平组间、时间、交互比较差异均有统计学意义(P<0.05)。组内比较:T_(1)~T_(4)时,两组Glu、Cor及NE水平均高于T_(0)时,差异有统计学意义(P<0.05);T_(2)~T_(4)时,两组Glu水平均高于T_(1)时,对照组NE水平均高于T_(1)时,差异有统计学意义(P<0.05);T_(3)时,观察组NE水平高于T_(1)、T_(2)时,差异有统计学意义(P<0.05);T_(4)时,观察组Glu水平高于T_(2)~T_(3)时,对照组NE水平均高于T_(2)~T_(3)时,差异有统计学意义(P<0.05);两组Glu、NE水平其他时间点两两比较差异均无统计学意义;T_(1)~T_(4)时,两组Cor水平两两比较差异均无统计学意义。组间比较:T_(0)时,两组Glu、Cor及NE水平比较差异均无统计学意义;T_(1)~T_(4)时,观察组Glu、Cor及NE水平均明显低于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分法(VAS)评分组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:观察组术后各时间点VAS评分均高于前一时间点,差异有统计学意义(P<0.05);术后4、8、12及24 h,对照组VAS评分均高于术后2 h,术后8、12 h均高于术后4 h,术后24 h均低于术后8、12 h,差异有统计学意义(P<0.05)。组间比较:术后2、4、8、12及24 h,观察组VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。观察组术后不良反应发生率为13.33%,对照组为18.19%,两组不良反应发生率比较差异无统计学意义。结论超声引导下右美托咪定复合罗哌卡因腹横肌平面阻滞可提高结肠癌患者术中麻醉效果,减轻应激反应,且安全性高,值得临床推广应用。

Objective To investigate the effect of ultrasound-guided dexmedetomidine combined with ropivacaine transversal plane block in laparoscopic surgery for colon cancer.Methods A total of 89 patients who underwent laparoscopic radical colon cancer resection in our hospital from December 2019 to December 2020 were selected as the research subjects,and they were divided into the observation groups(n=45,the order of treatment was odd)and the control group(n=44,the order of visits was even)according to the order number of treatment.The two groups were given the same anesthesia induction before surgery,the control group was given ropivacaine transversal plane block under ultrasound guidance after anesthesia induction,and the observation group was added dexmedetomidine on the basis of the control group.The stress response index(blood glucose[Glu],cortisol[Cor]and norepinephrine[NE])at each time during the perioperative period,and postoperative pain degree at various time points after surgery and occurrence of adverse reactions were compared between the two groups.Results There were significant differences in Glu,Cor and NE levels between the two of groups groups,time points and interaction(P<0.05).Comparison within groups:at T_(1)to T_(4),Glu,Cor and NE levels of the two groups were higher than T_(0)levels,and the differences were statistically significant(P<0.05);at T_(2)to T_(4),Glu level of the two groups was higher than T_(1),NE level in the control group was higher than T_(1),and the difference was statistically significant(P<0.05);at T_(3),NE level in the observation group was higher than that at T_(1)and T_(2),and the difference was statistically significant(P<0.05);at T_(4),Glu level in the observation group was higher than T_(2)to T_(3),NE level in the control group was higher than T_(2)to T_(3),the differences were statistically significant(P<0.05);there were no significant differences in Glu and NE levels between the two groups at other time points;there was no significant difference in Cor level between the two groups at T_(1)to T_(4),the difference was statistically significant(P<0.05).Comparison between groups:at T_(0),there were no significant differences in Glu,Cor and NE levels between the two groups;at T_(1)to T_(4),the levels of Glu,Cor and NE in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).There were significant differences in visual analogue scale(VAS)scores between two gorups of groups,time points and interaction(P<0.05).Comparison within groups:the VAS scores at each time points after surgery in the observation group were higher than those in the previous time point,and the differences were statistically significant(P<0.05);at 4,8,12 and 24 h after surgery,the VAS scores in the control group were higher than those at 2 h after surgery,at 8,12 h after surgery were higher than those at 4 h after surgery,and those at 24 h were lower than those at 8 and 12 h after surgery,the differences were statistically significant(P<0.05).Comparison between groups:at 2,4,8,12 h and 24 h after surgery,VAS scores in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions was 13.33%in the observation group and 18.19%in the control group,there was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Ultrasound-guided dexmedetomidine combined with ropivacaine transversal plane block can improve the anesthesia effect and reduce the degree of stress reaction in patients with colon cancer,it is safe and worthy of clinical promotion and application.