摘要
目的探讨罗哌卡因联合右美托咪定腹横肌平面阻滞对腹腔镜胃癌根治术患者术后应激激素及认知功能的影响。方法选择2023年4至10月于新乡医学院第一附属医院行腹腔镜胃癌根治术的80例患者为研究对象,根据麻醉方法不同将患者分为观察组和对照组,每组40例。观察组患者注射2.5 g·L^(-1)罗哌卡因与右美托咪定(0.5μg·kg^(-1))混合液行双侧腹横肌平面阻滞,每侧注射20 mL;对照组患者注射2.5 g·L^(-1)罗哌卡因行双侧腹横肌平面阻滞,每侧注射20 mL。记录患者入手术室(T_(1))、气管插管后即刻(T_(2))、气腹后40 min(T_(3))、气管拔管后15 min(T_(4))的平均动脉压(MAP)、心率(HR)。于术后1、6、12、24 h,应用放射性免疫沉淀法检测血清中皮质醇(COR)水平,酶联免疫吸附试验法检测血清中去甲肾上腺素(NE)、肾上腺素(E)水平,视觉模拟评分法(VAS)评估患者静息状态下疼痛程度,Ramsay评分(RSS)评估患者的镇静深度。比较2组患者丙泊酚及舒芬太尼的用量。于术前1 d、术后1 d、术后3 d,应用酶联免疫吸附试验法检测2组患者血清中β淀粉样蛋白(Aβ)及S100β蛋白水平,使用简易智力状态检查量表(MMSE)评估患者的认知功能。结果T_(1)、T_(2)时,对照组与观察组患者的MAP和HR比较差异无统计学意义(P>0.05);T_(3)、T_(4)时,观察组患者的MAP和HR显著低于对照组(P<0.05)。术后1、6、12 h,观察组患者的VAS评分显著低于对照组(P<0.05);术后24 h,对照组与观察组患者的VAS评分比较差异无统计学意义(P>0.05)。术后1、6 h,观察组患者的Ramsay评分显著高于对照组(P<0.05);术后12、24 h,对照组与观察组患者的Ramsay评分比较差异无统计学意义(P>0.05)。术后1、6、12 h,观察组患者血清中COR、NE和E水平显著低于对照组(P<0.05);术后24 h,对照组与观察组患者血清中COR、NE和E水平比较差异无统计学意义(P>0.05)。观察组患者的丙泊酚及舒芬太尼的
Objective To explore the effect of ropivacaine combined with dexmedetomidine in transversus abdominis plane block(TAPB)on postoperative stress hormones and cognitive function in patients undergoing laparoscopic radical gastrectomy.Methods A total of 80 patients undergoing laparoscopic radical gastrectomy at the First Affiliated Hospital of Xinxiang Medical University from April to October 2023 were selected as the research subjects.According to different anesthesia methods,the patients were divided into the observation group and the control group,with 40 patients in each group.Patients in the observation group were injected bilaterally with 2.5 g·L^(-1)ropivacaine and 0.5μg·kg^(-1)dexmedetomidine for TAPB,with 20 mL injection on each side.Patients in the control group were injected bilaterally with 2.5 g·L^(-1)ropivacaine for TAPB,with 20 mL injection on each side.Mean arterial pressure(MAP)and heart rate(HR)were recorded at the time of admission to the operating room(T_(1)),immediately after endotracheal intubation(T_(2)),40 minutes after pneumoperitoneum(T_(3)),and 15 minutes after extubation(T_(4)).Radioimmunoprecipitation was used to detect serum cortisol(COR)level,and enzyme-linked immunosorbent assay was used to measure serum norepinephrine(NE)and epinephrine(E)levels at 1,6,12,and 24 hours after surgery.Visual analog scale(VAS)was used to assess pain at rest,and Ramsay sedation scale(RSS)was used to evaluate sedation depth.The doses of propofol and sufentanil were compared between the two groups.Serumβ-amyloid(Aβ)and S100βprotein levels at 1 day before surgery,1 and 3 days after surgery were detected by using the enzyme-linked immunosorbent assay,and cognitive function was assessed at the same time points by using the mini-mental state examination(MMSE).Results At T_(1)and T_(2),there was no significant difference in MAP and HR between the control group and the observation group(P>0.05).At T_(3)and T_(4),MAP and HR in the observation group were significantly lower than those in the control group(P<0
作者
张红伟
王卫卫
李晓芳
樊藤
马文珂
岳修勤
ZHANG Hongwei;WANG Weiwei;LI Xiaofang;FAN Teng;MA Wenke;YUE Xiuqin(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Neonatology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2024年第3期245-250,256,共7页
Journal of Xinxiang Medical University
基金
河南省医学教育研究项目(编号:Wjlx2022099)
新乡医学院第一附属医院青年培育基金(编号:QN-2020-A03)。
关键词
右美托咪定
应激激素
腹横肌平面阻滞
胃癌根治术
认知功能
dexmedetomidine
stress hormones
transversus abdominis plane block
radical gastrectomy
cognitive function
