环泊酚与小剂量右美托咪定复合镇痛腹腔镜胆囊切除术治疗胆囊结石患者麻醉效果研究

Analgesia with ciprofol and dexmedetomidine combination in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy

目的观察环泊酚与小剂量右美托咪定复合镇痛腹腔镜胆囊切除术(LC)治疗的胆囊结石患者的麻醉效果。方法2023年2月~2023年6月我院收治的69例胆囊结石患者被随机分为对照组34例和观察组35例,两组均接受LC治疗。在手术时,给予对照组环泊酚麻醉镇痛,给予观察组环泊酚复合小剂量右美托咪定麻醉镇痛。此后,均采用吸入麻醉。在插管前(T0)和拔管后10 min(T2)采用疼痛视觉模拟(VAS)法和Ramsay镇静量表评估麻醉效果。在T0、插管后10 min(T1)和T2时,监测收缩压(SBP)、舒张压(DBP)和心率(HR)。采用ELISA法检测血清白细胞介素-1β(IL-1β)、IL-6和肿瘤坏死因子-α(TNF-α)水平。结果在T2时,观察组VAS和Ramsay评分分别为(3.5±0.3)分和(2.7±0.5)分,显著低于对照组【分别为(3.9±0.4)分和(3.3±0.5)分,P<0.05】;观察组苏醒时间和拔管时间分别为(12.4±2.7)min和(16.2±2.9)min,显著短于对照组【(16.8±3.3)min和(19.7±3.8)min,P<0.05】;在T1时,观察组SBP、DBP和HR分别为(118.7±8.6)mmHg、(71.0±6.3)mmHg和(78.8±7.4)次/min,显著低于或慢于对照组【分别为(124.1±9.3)mmHg、(74.6±6.5)mmHg和(82.6±6.7)次/min,P<0.05】;在T2时,观察组SBP、DBP和HR分别为(121.4±10.5)mmHg、(76.6±5.9)mmHg和(76.2±6.7)次/min,显著低于或慢于对照组【分别为(127.6±10.2)mmHg、(81.6±6.1)mmHg和(80.8±8.6)次/min,P<0.05】;在术后3 d,观察组血清IL-1β、IL-6和TNF-α水平分别为(41.3±7.1)pg/mL、(108.9±20.5)pg/mL和(14.7±2.7)pg/mL,显著低于对照组【分别为(46.9±8.4)pg/mL、(122.8±24.7)pg/mL和(19.2±3.9)pg/mL,P<0.05】。结论应用环泊酚与小剂量右美托咪定复合镇痛能够减轻接受LC手术患者疼痛,为手术展开提供稳定的血流动力学条件,可能与抑制了机体应激反应有关。

Objective The aim of this study was to investigate the analgesia with ciprofol and dexmedetomidine combination in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy(LC).Methods 69 patients with cholecystolithiasis were enrolled in our hospital between February 2023 and June 2023,and were randomly divided into control(n=34)and observation group(n=35),and all patients in the two groups received LC.For analgesia,the ciprofol was given in patients in the control,and the ciprofol and low-dose of dexmedetomidine combination were given in patients in the observation during perioperative period.Thereafter,the aspiration anaesthesia was carried out.The visual analogue scale(VAS)and Ramsay sedation scale were applied to evaluate the anesthetic effect before intubation(T0)and 10 min after extubation(T2).The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were measured by multifunctional monitor at T0,10 min after intubation(T1)and T2.Serum interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)levels were measured by ELISA.Results At T2,the VAS and Ramsay scores in the observation group were(3.5±0.3)and(2.7±0.5),both significantly lower than[(3.9±0.4)and(3.3±0.5),respectively,P<0.05]in the control;the wakening time and extubation time in the observation group were(12.4±2.7)min and(16.2±2.9)min,both significantly shorter than[(16.8±3.3)min and(19.7±3.8)min,P<0.05]in the control;at T1,the SBP,DBP and HR were(118.7±8.6)mmHg,(71.0±6.3)mmHg and(78.8±7.4)beats/min,all significantly lower or slower than[(124.1±9.3)mmHg,(74.6±6.5)mmHg and(82.6±6.7)beats/min,P<0.05]in the control;at T2,the SBP,DBP and HR were(121.4±10.5)mmHg,(76.6±5.9)mmHg and(76.2±6.7)beats/min,significantly lower or slower than[(127.6±10.2)mmHg,(81.6±6.1)mmHg and(80.8±8.6)beats/min,P<0.05]in the control;3 days after operation,serum IL-1β,IL-6 and TNF-α levels were(41.3±7.1)pg/mL,(108.9±20.5)pg/mL and(14.7±2.7)pg/mL,all significantly lower than[(46.9±8.4)pg/mL,(122.8±24.7)pg/mL and(19.2±3.9)pg/mL,respectively,P<0.05]in the control group.Conclusion The anesthesia with cyclopofol and low-dose of dexmedetomidine combination could relieve pain and provide stable hemodynamic conditions in patients with cholecystolithiasis underwent LC,which might be related to the mild stress of body reactions.