右美托咪定复合罗哌卡因行竖脊肌平面阻滞对胸腔镜肺癌手术患者镇痛效果、炎症应激及认知功能的影响

Effects of dexmedetomidine combined with ropivacaine for erector spinae plane blockon analgesic efficacy,inflammatory stress and cognitive function in patients undergoing thoracoscopic lung cancer surgery

目的探讨右美托咪定复合罗哌卡因行竖脊肌平面阻滞对胸腔镜肺癌手术患者镇痛效果、炎症应激及认知功能的影响。方法选择在江苏省邳州市人民医院接受胸腔镜肺癌手术的患者104例,以随机数字表法分为研究组(n=52)与对照组(n=52)。对照组接受竖脊肌平面阻滞复合全身麻醉,在对照组的基础上,研究组竖脊肌平面阻滞中加用右美托咪定复合罗哌卡因。对比2组镇痛效果、炎症反应、氧化应激反应、认知功能及麻醉相关不良反应。结果术后2组视觉模拟评分(visual analogue scale,VAS)评分均逐渐降低,在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。术后2组血清肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)水平均先升高后降低,在组间、时间点、组间·时点间交互作用差异均有统计学意义(P<0.05)。术后2组血清超氧化物歧化酶(superoxide dismutase,SOD)水平均逐渐升高,在组间、时间点、组间·时点间交互作用差异均有统计学意义(P<0.05)。术后2组血清丙二醛(malondialdehyde,MDA)水平均逐渐降低,在组间、时间点、组间·时点间交互作用差异均有统计学意义(P<0.05)。术后2组简明精神状态量表(mini-mental state examination,MMSE)评分均逐渐降低,在组间、时间点、组间·时点间交互作用差异均有统计学意义(P<0.05)。2组麻醉相关不良反应总发生率比较差异无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因行竖脊肌平面阻滞用于胸腔镜肺癌手术患者中镇痛效果确切,可减轻患者炎症反应与氧化应激反应,改善认知功能,且安全性良好。

Objective To investigate the effects of dexmedetomidine combined with ropivacaine for erector spinae plane block(ESPB)on analgesic efficacy,inflammatory stress and cognitive function in patients undergoing thoracoscopic lung cancer surgery.Methods A total of 104 patients who underwent thoracoscopic lung cancer surgery in Pizhou People's Hospital,Jiangsu Province,were selected and divided into research group(n=52)and control group(n=52)by random number table method.The control group received ESPB combined with general anesthesia.On the basis of the control group,the research group was supplemented with dexmedetomidine combined with ropivacaine.The analgesic efficacy,inflammatory response,oxidative stress response,cognitive function and anesthesia-related adverse reactions were compared between the two groups.Results The visual analogue scale(VAS)score of both groups decreased gradually after surgery,and there were significant differences in interaction between groups,time points and time points between groups(P<0.05).After surgery,the serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in both groups first increased and then decreased,and there were significant differences in interactions between groups,time points,and time points between groups(P<0.05).After surgery,the serum superoxide dismutase(SOD)level of the two groups increased gradually,and there were significant differences in interactions between groups,time points,and time points between groups(P<0.05).The level of serum malondialdehyde(MDA)in the two groups decreased gradually after surgery,and there were significant differences in interactions between groups,time points,and time points between groups(P<0.05).After surgery,the scores of mini-mental state examination(MMSE)in both groups gradually decreased,and there were significant differences in interactions between groups,time points,and time points between groups(P<0.05).There was no difference in the total incidence of anesthesia-related adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with ropivacaine for ESPB is effective for analgesia in patients undergoing thoracoscopic lung cancer surgery,which can reduce the inflammatory response and oxidative stress response,and improve cognitive function,with good safety.