罗哌卡因复合曲马多腰方肌阻滞对老年前列腺癌手术的应用效果

Effects of ropivacaine mixed with tramadol for quadratus lumborum block on postoperative cognition and rapid recovery in elderly patients with prostate cancer

目的观察罗哌卡因复合曲马多腰方肌阻滞对老年前列腺癌手术的应用效果。方法选择择期行腹腔镜前列腺癌根治术的老年患者50例,随机分为对照组和试验组,每组25例。所有患者均予气管插管、全凭静脉麻醉联合双侧腰方肌阻滞麻醉。麻醉诱导前20 min,对照组每侧腰方肌予0.3%罗哌卡因25 mL行双侧腰方肌阻滞,试验组每侧腰方肌予以0.3%罗哌卡因复合曲马多2 mg·kg^(-1)(共25 mL)行双侧腰方肌阻滞。记录2组切皮前5 min、切皮后10 min、术毕、拔管后10 min的平均动脉压(MAP)和心率(HR),以及术中瑞芬太尼用量和苏醒期镇静-躁动(SAS)评分;评估2组术后2、12、24和48 h疼痛评分(PHPS评分);于术前1 h、术后2 h采集中心静脉血,检测C反应蛋白(CRP)及高迁移率族蛋白B1(HMGB1)水平;术前1 d、术后24 h采用蒙特利尔认知评估量表(MoCA)评估患者的认知情况;记录术后首次活动时间、排气时间、进食时间及患者术后满意度评分。结果试验组患者切皮后10 min、术毕、拔管后10 min的MAP和HR低于对照组(P<0.05),术中瑞芬太尼使用量少于对照组(P<0.05),苏醒期SAS评分低于对照组(P<0.05)。术后24和48 h,试验组PHPS评分低于对照组(P<0.05)。术后2 h,试验组CRP和HMGB1水平均低于对照组(P<0.05)。术后24 h,试验组患者MoCA评分高于对照组(P<0.05)。试验组患者术后首次活动时间、排气时间及进食时间均短于对照组(P<0.05),试验组患者术后满意度评分高于对照组(P<0.05)。结论罗哌卡因复合曲马多腰方肌阻滞用于老年前列腺癌手术可以稳定围术期血流动力学,具有更好的术后镇痛效果,可以降低术后炎症因子水平,提高术后认知功能,有利于术后快速康复。

AIM To observe the effects of ropivacaine mixed with tramadol for quadratus lumborum block(QLB)on postoperative cognition and rapid recovery in elderly prostate cancer surgery.METHODS 50 elderly patients undergoing laparoscopic radical prostatectomy were randomized into control group(group C)and trial group(group T),with 25 patients in each group.All patients received endotracheal intubation total intravenous anesthesia combined with bilateral QLB anesthesia.Patients in group C received 25mL of 0.3%ropivacaine,while patients in group T received 25 mL of 0.3%ropivacaine mixed with tramadol 2 mg·kg^(-1)on each side 20 min before anesthesia.The mean arterial pressure(MAP)and heart rate(HR)at 5 minutes before skin incision,10 minutes after skin incision,the end of surgery and 10 minutes after extubation,intraoperative remifentanil dosage,and sedation-agitation scale(SAS)score after awakening were recorded.The Prince-Henry pain score(PHPS)was evaluated at 2,12,24,and 48h after surgery.Central venous blood was collected and the serum levels of C-reactive protein(CRP)and high mobility group box protein 1(HMGB1)were tested 1 h before surgery and 2 h after the surgery.Patients'cognitive function was evaluated at 1 d before surgery and 24 h after surgery using the Montreal cognitive assessment(MoCA)table,and the postoperative first activity time,anus exhaust time,eating time and patients'satisfaction score were also recorded.RESULTS Compared with group C,MAP and HR at 10 minutes after skin incision,the end of surgery and 10 minutes after extubation were lower in group T(P<0.05),the remifentanil dosage was reduced in group T(P<0.05),and the awakening SAS score was lower in group T(P<0.05).At 24 and 48 h after surgery,the PHPS was lower in group T than in group C(P<0.05).The CRP and HMGB1levels at 2h after the surgery were lower in group T than in group C(P<0.05).Compared with group C,the MoCA scores at 24 h after surgery were higher in group T(P<0.05).The postoperative first activity time,anus exhaust time and eating time were significantly shorter in group T than in group C(P<0.05).Patients in group T had higher satisfaction scores than those in group C(P<0.05).CONCLUSION Ropivacaine mixed with tramadol for quadratus lumborum block(QLB)applied in elderly prostate cancer surgery,can maintain a more stable perioperative hemodynamics,provide better postoperative analgesia,reduce levels of inflammatory cytokines CRP and HMGB1,improve postoperative cognitive function and is conducive to rapid recovery after surgery.