全麻复合不同浓度罗哌卡因腹横肌平面阻滞在腹腔镜下阑尾切除术中的镇痛效果及安全性分析

Analgesic effect and safety analysis of general anesthesia combined with different concentration of Ropivacaine transversal abdo-minal plane block in laparoscopic appendectomy

目的探究全麻复合不同浓度罗哌卡腹横肌平面阻滞在腹腔镜下阑尾切除术中的镇痛效果及安全性。方法选取安徽省淮北矿工总医院2021年1月至2023年4月收治的腹腔镜下阑尾切除术患者82例,采用随机数字表法将其分为对照组与研究组,各41例。对照组采用0.25%的罗哌卡因进行麻醉,研究组采用0.50%的罗哌卡因进行麻醉。比较两组手术时间、麻醉时间、术中出血量及拔管时间;比较两组麻醉前(T_(0))、拔管时(T_(1))、拔管后30 min(T_(2))平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)评分、5-羟色胺(5-HT)、P物质;记录两组不良反应发生情况;比较两组临床疗效。结果研究组手术时间、麻醉时间、拔管时间短于对照组,术中出血量低于对照组(P<0.05)。两组MAP时间、组间、交互作用比较,差异有统计学意义(P<0.05);两组HR时间、组间比较,差异有统计学意义(P<0.05)。组内比较:两组不同时间点MAP、HR组内两两比较,差异有统计学意义(P<0.05)。组间比较:T_(1)~T_(2)时,研究组MAP、HR高于对照组(P<0.05)。两组VAS评分、5-HT、P物质时间、组间、交互作用比较,差异有统计学意义(P<0.05)。组内比较:两组不同时间点VAS评分、5-HT、P物质组内两两比较,差异有统计学意义(P<0.05)。组间比较:T_(1)~T_(2)时,研究组VAS评分、5-HT、P物质低于对照组(P<0.05)。研究组不良反应总发生率高于对照组(P<0.05)。研究组临床疗效优于对照组(P<0.05)。结论腹腔镜下阑尾全麻切除术中0.50%的罗哌卡因相较于0.25%的罗哌卡因的镇痛效果更佳,且能有效降低患者疼痛程度,安全性较高。

Objective To explored the analgesic effect and safety of general anesthesia combined with different concentrations of Ropivacaine transversal abdo-minal plane block in laparoscopic appendectomy.Methods A total of 82 patients with laparoscopic appendectomy admitted to Huaibei Miners General Hospital of Anhui Province from January 2021 to April 2023 were selected,and they were divided into control group and study group by random number table method,with 41 cases in each group.The control group received anesthesia with 0.25%Ropivacaine,while study group received anesthesia with 0.50%Ropivacaine.Operation time,anesthesia time,intraoperative blood loss,and extubation time were compared between two groups;the mean arterial pressure(MAP),heart rate(HR),visual analogue scale(VAS)score,5-hydroxytryptamine(5-HT),and substance P were compared between two groups before anesthesia(T_(0)),at extubation(T_(1)),and 30 minutes after extubation(T_(2));the occurrence of adverse reactions in two groups were recorded;and the clinical efficacy of two groups was compared.Results The operation time,anesthesia time,and extubation time of study group were shorter than those of control group,and the amount of intraoperative blood loss was lower than that of control group(P<0.05).There were statistically significant differences in time,inter-group,and interaction of MAP between two groups(P<0.05);there were significant differences in time and inter-group of HR between two groups(P<0.05).Intra-group comparison:pairwise comparison of MAP and HR groups at different time points between two groups showed statistical significance(P<0.05).Comparison between groups:at T_(1)-T_(2),MAP and HR in study group were higher than those in control group(P<0.05).There were statistically significant differences in time,inter-group,and interaction of VAS score,5-HT,and substance P between two groups(P<0.05).Intra-group comparison:pairwise comparison of VAS score,5-HT,and substance P at different time points between two groups had statistical significances(P<0.05).Comparison between groups:at T_(1)-T_(2),VAS score,5-HT,and substance P in study group were lower than those in control group(P<0.05).The total incidence of adverse reactions in study group was higher than that in control group(P<0.05).The clinical effect of study group was better than that of control group(P<0.05).Conclusion Compared with 0.25%Ropivacaine,the analgesic effect of 0.50%Ropivacaine in laparoscopic appendectomy is better,and it can effectively reduce the pain degree of patients with higher safety.