罗哌卡因联合七氟醚吸入麻醉效果及对患者LM术中预后影响

Anesthetic effect of ropivacaine combined with sevoflurane inhalation anesthesia used during laparoscopic hysteromyomectomy of patients with uterine fibroids and its influence on their prognosis

目的:探讨腹腔镜子宫肌瘤切除术(LM)术中应用罗哌卡因联合七氟醚吸入麻醉对子宫肌瘤(UF)患者麻醉效果以及预后影响。方法:选取2022年4月-2024年2月于本院行LM术UF患者128例,双盲法随机分为联合组和七氟醚组各64例,比较两组麻醉效果、围术期血流动力学、疼痛程度(视觉模拟评分)、炎性因子水平变化,以及术后认知功能(MMSE、MoCA评分)恢复程度。结果:术后联合组自主呼吸恢复(6.12±0.86 min)、唤醒(3.56±0.78 min)、言语应答(7.62±0.53 min)与拔管(14.65±2.26 min)等时间均短于七氟醚组(7.34±1.36 min、4.89±0.93 min、10.58±1.17 min、17.56±2.78 min),心率(71.43±6.07次/min)、平均动脉压(88.93±6.54 mmHg)水平高于七氟醚组(69.34±5.32次/min、86.51±6.91 mmHg),术后12h视觉模拟评分(2.41±0.49分)、术后血清肿瘤坏死因子-α(18.96±3.07 ng/L)、白细胞介素-6(18.54±3.08 pg/ml)水平均低于七氟醚组(3.65±0.68分、26.94±4.53 ng/L、24.83±4.15 pg/ml),术后1d MMSE(27.39±1.58分)及MoCA(28.42±0.97分)评分均高于七氟醚组(25.86±1.64分、26.48±1.03分)(均P<0.05)。结论:罗哌卡因联合七氟醚对行LM术UF患者具有良好麻醉效果,能稳定患者血流动力学、减轻痛感并抑制炎症应激反应,同时促进患者认知功能恢复,对临床麻醉应用有参考意义。

Objective:To investigate the anesthesia effect of ropivacaine combined with sevoflurane inhalation anesthetic used during laparoscopic hysteromyomectomy(LM)of patients with uterine fibroids(UF),and to study its influence on the prognosis of the patients.Methods:A total of 128 patients with UF who wanted LM were vselected and were randomly divided into study group(64 patients with ropivacaine combined with sevoflurane inhalation for anesthesia)and control group(64 patients with sevoflurane inhalation for anesthesia)by double-blind method from April 2022 to February 2024.The anesthetic effect,the perioperative hemodynamics,the pain degree evaluated by visual analogue scale(VAS),the inflammatory factors levels change and the recovery of postoperative cognitive function evaluated by MMSE and MoCA scores of the patients were compared between the two groups.Results:The time of spontaneous breathing recovery(6.12±0.86 min),the time of wake-up(3.56±0.78 min),the verbal response time(7.62±0.53min)and the extubation time(14.65±2.26 min)of the patients in the study group after operation were significantly shorter than those(7.34±1.36 min,4.89±0.93 min and 10.58±1.17 min and 17.56±2.78 min)of the patients in the control group.The heart rate(71.43±6.07 beats/min)and the mean arterial pressure(88.93±6.54 mmHg)of the patients in the study group after operation were vsignificantly higher than those(69.34±5.32 beats/min and 86.51±6.91mmHg)of the patients in the control group.The visual analogue score(2.41±0.49 points),and the levels of serum tumor necrosis factor-α(18.96±3.07 ng/L)and interleukin-6(18.54±3.08 pg/ml)of the patients in the study group at 12 hours after operation were significantly lower than those(3.65±0.68 points,26.94±4.53 ng/L and 24.83±4.15pg/ml)of the patients in the control group.The scores of MMSE(27.39±1.58 points)and MoCA(28.42±0.97 points)of the patients in the study group in 1 day after operation were significantly higher than those(25.86±1.64 points and26.48±1.03 points)of the patients in the control group(all P<0.05).Conclusion:Ropivacaine combined with sevoflurane inhalation anesthesia used during LM of the patients with UF has the good anesthetic effect,can stabilize the hemodynamics,reduce the pain degree,inhibit the inflammatory stress response and promote the recovery of cognitive function of the patients,and which has important reference significance for the clinical anesthesia application.