右美托咪定联合酮咯酸氨丁三醇超前镇痛对腹腔镜下胆囊切除术患者麻醉效果的影响

Effect of Dexmedetomidine Combined with Ketorolac Tromethamine Preemptive Analgesia on Anesthesia in Patients Undergoing Laparoscopic Cholecystectomy

目的:探究右美托咪定酮咯酸氨丁三醇超前镇痛对腹腔镜下胆囊切除术(LC)患者麻醉苏醒质量、镇痛、镇静效果、应激反应的影响。方法:选取濮阳市第三人民医院2020年1月—2022年12月收治的80例LC患者,根据随机数字表法分为常规组和联合组,各40例。常规组在常规麻醉前采用酮咯酸氨丁三醇进行超前镇痛,联合组在常规麻醉前采用右美托咪定联合酮咯酸氨丁三醇进行超前镇痛。比较两组麻醉苏醒质量、术后不同时间点镇静[Ramsay镇静量表评分(RSS)]、镇痛效果[疼痛视觉模拟量表(VAS)]、应激反应[胰岛素样生长因子-1(IGF-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6]、不良反应。结果:联合组拔管、苏醒时间及自主呼吸、定向力恢复时间短于常规组(P<0.05)。术后6 h、12 h时,联合组RSS评分高于常规组,VAS评分低于常规组(P<0.05)。术后6 h时,联合组血清IGF-1水平高于常规组,血清TNF-α、IL-1β、IL-6水平低于常规组(P<0.05)。苏醒后,联合组不良反应发生率(7.50%)与常规组(12.50%)比较,差异无统计学意义(P>0.05)。结论:右美托咪定联合酮咯酸氨丁三醇超前镇痛用于LC术中具有较好的镇痛、镇静效果,能减轻患者术后应激反应,提升麻醉苏醒质量,且不良反应较少,具有较高的安全性。

Objective:To investigate the effects of dexmedetomidine ketorolac tromethamine preemptive analgesia on the quality of anesthesia recovery,analgesia,sedation and stress response in patients undergoing laparoscopic cholecystectomy(LC).Methods:A total of 80 LC patients admitted to the Third People's Hospital of Puyang from January 2020 to December 2022 were selected and divided into routine group and combined group according to the random number table method,with 40 patients in each group.The routine group was given ketorolac tromethamine for preemptive analgesia before routine anesthesia,and the combined group was given dexmedetomidine combined with ketorolac tromethamine for preemptive analgesia before routine anesthesia.The quality of anesthesia recovery,sedation at different time points after operation[Ramsay sedation scale score(RSS)],analgesic effect[visual analogue scale(VAS)],stress response[insulin-like growth factor-1(IGF-1),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-6]and adverse reactions were compared between the two groups.Results:The extubation,recovery time,spontaneous breathing and directional force recovery time in the combined group were shorter than those in the routine group(P<0.05).At 6 h and 12 h after operation,the RSS score of the combined group was higher than that of the conventional group,and the VAS score was lower than that of the routine group(P<0.05).At 6 h after operation,the serum IGF-1 level in the combined group was higher than that in the routine group,and the serum TNF-α,IL-1β and IL-6 levels were lower than those in the routine group(P<0.05).After awakening,there was no significant difference in the incidence of adverse reactions between the combined group(7.50%)and the routine group(12.50%)(P>0.05).Conclusion:Dextrmetomidine combined with ketorolac tromethamine for preemptive analgesia during LC surgery has a good analgesic and sedative effect,which can reduce postoperative stress reactions,improve the quality of anesthesia and recovery,and has fewer adverse reactions,with high safety.