罗哌卡因联合右美托咪定腹横肌平面阻滞在中老年腹腔镜直肠癌根治术中的应用效果

Effect of Ropivacaine Combined with Dexmedetomidine on the Analgesic Effect and Stress Hormone in Middle-Aged and Elderly Patients Undergoing Laparoscopic Radical Resection of Rectal Cancer

目的探究罗哌卡因联合右美托咪定腹横肌平面阻滞对中老年腹腔镜直肠癌根治术后疼痛和应激反应的影响。方法选择新乡医学院第一附属医院择期接受腹腔镜直肠癌根治术患者90例,根据腹横肌阻滞用药将患者分为A组、B组和C组,每组30例,A组接受罗哌卡因与右美托咪定双侧腹横肌平面阻滞,B组接受罗哌卡因双侧腹横肌平面阻滞,C组不接受腹横肌平面阻滞。记录各组患者入室稳定状态(T_(0))、气管插管即刻(T_(1))、气腹后30 min时(T_(2))、气管拔管10 min后(T_(3))时的平均动脉压(MAP)和心率(HR)。监测术后的血清皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)水平及静息视觉模拟评分法(VAS)评分、Ramsay评分。记录术后镇痛泵按压次数、拔管时间、麻醉后护理单元(PACU)停留时间。结果T_(2)时间点A组患者的MAP低于B组和C组(P<0.05);T_(3)时间点,A组患者的MAP低于B组和C组,且B组的MAP低于C组(P<0.05);T_(2)、T_(3)时间点A组患者的HR低于B组和C组(P<0.05)。A组和B组患者的拔管时间和PACU停留时间短于C组(P<0.05);A组患者的术后镇痛泵按压次数少于B组和C组(P<0.05),且B组少于C组(P<0.05)。A组和B组术后2、6 h的静息VAS评分、Ramsay评分低于C组,且A组低于B组(P<0.05),术后12 h的静息VAS评分,A组低于B组、C组(P<0.05)。术后2、12 h,A组和B组的NE、E、COR水平低于C组,且A组低于B组(P<0.05)。3组患者的术中低血压、恶心呕吐、寒战、头晕头痛等差异无统计学意义(P>0.05)。结论腹横肌平面阻滞中罗哌卡因与右美托咪定联合应用可有效减轻中老年腹腔镜直肠癌根治术后的疼痛和应激反应,改善术后镇痛效果,并提高患者的术后舒适度。

Objective To investigate the effect of combined ropivacaine and dexmedetomidine transversus abdominis plane block on pain and stress response after laparoscopic radical resection of rectal cancer in middle-aged and elderly patients.Methods Ninety patients scheduled for laparoscopic radical rectal cancer surgery at the First Affiliated Hospital of Xinxiang Medical University were selected.According to different medications for transversus abdominis plane block,patients were divided into group A,group B,and group C,with 30 cases in each group.Group A received bilateral transversus abdominis plane block with ropivacaine combined with dexmedetomidine,group B received bilateral transversus abdominis plane block with ropivacaine,group C did not undergo transversus abdominis plane block.Mean arterial pressure(MAP)and heart rate(HR)were recorded at the stable state upon entry to the operating room(T_(0)),immediately after tracheal intubation(T_(1)),30 minutes after pneumoperitoneum(T_(2)),and 10 minutes after tracheal extubation(T_(3)).The postoperative serum cortisol(Cor),norepinephrine(NE),and epinephrine(E)levels,resting visual analog scale(VAS)score,and Ramsay score were monitored.The number of postoperative analgesia pump presses,extubation time,and post-anesthesia care unit(PACU)dwell time were recorded.Results At time point T_(2),the MAP of group A patients was lower than that of group B and group C(P<0.05).At time point T_(3),the MAP of group A patients was lower than that of group B and group C,and the MAP of group B was lower than that of group C(P<0.05).At time points T_(2) and T_(3),the HR of group A patients was lower than that of group B and group C(P<0.05).The extubation time and PACU retention time of patients in group A and group B were shorter than those in group C(P<0.05).The number of postoperative analgesia pump presses in group A patients was less than that in group B and group C(P<0.05),and group B was less than group C(P<0.05).The resting VAS score and Ramsay score of group A and group B were lower than those of group C at 2 and 6 hours after surgery,and group A was lower than group B(P<0.05).The resting VAS score of group A at 12 hours after surgery was lower than that of group B and group C(P<0.05).At 2 and 12 hours post surgery,the NE,E,and COR levels in group A and group B were lower than those in group C,and group A was lower than group B(P<0.05).There was no statistically difference in intraoperative hypotension,nausea and vomiting,chills,dizziness and headache among the three groups of patients(P>0.05).Conclusion Combined use of ropivacaine and dexmedetomidine in transversus abdominis plane block effectively reduces postoperative pain and stress response in middle-aged and elderly patients undergoing laparoscopic radical rectal cancer surgery,improves postoperative analgesia,and enhances patient comfort.