| 唐 佳,张慕春,王朵朵,储昭霞,胡宪文.右美托咪定联合罗哌卡因腹横肌平面阻滞对老年腹腔镜胃癌根治术患者应激反应、炎症反应及术后谵妄的影响[J].,2021,(19):3743-3747 |
| 右美托咪定联合罗哌卡因腹横肌平面阻滞对老年腹腔镜胃癌根治术患者应激反应、炎症反应及术后谵妄的影响 |
| Effects of Dexmedetomidine Combined with Ropivacaine Transverse Abdominis Plane Block on Stress Response, Inflammatory Response and Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Radical Gastrectomy for Gastric Cancer |
| 投稿时间：2021-02-05 修订日期：2021-02-27 |
| DOI：10.13241/j.cnki.pmb.2021.19.029 |
| 中文关键词: 右美托咪定 罗哌卡因 腹横肌平面阻滞 老年 腹腔镜胃癌根治术 应激反应 炎症反应 谵妄 |
| 英文关键词: Dexmedetomidine Ropivacaine Transversus abdominis plane block Elderly Laparoscopic radical gastrectomy for gastric cancer Stress response Inflammatory response Delirium |
| 基金项目:国家自然科学基金项目(81471341)；中科院合肥研究院医学物理中心医研协同创新联合基金项目（LHJJ202004） |
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| 摘要 目的：探讨右美托咪定联合罗哌卡因腹横肌平面阻滞（TAPB）对老年腹腔镜胃癌根治术患者炎症反应、应激反应及术后谵妄的影响。方法：选择2017年7月~2019年10月期间我院接收的行腹腔镜胃癌根治术的老年患者118例，按随机信封抽签法将其分为A组（n=59，罗哌卡因TAPB麻醉）和B组（n=59，右美托咪定联合罗哌卡因TAPB麻醉），对比两组血流动力学指标、应激反应、炎症反应、术后疼痛、术后谵妄及不良反应发生率。结果：两组TAPB阻滞即刻（T1）~拔管时（T4）时间点心率（HR）、平均动脉压（MAP）均较麻醉前（T0）时间点升高（P<0.05），B组T1~T4时间点HR、MAP低于A组（P<0.05）。两组术后3 d、术后5 d皮质醇（Cor）、去甲肾上腺素（NE）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平高于术前，但术后5 d 低于术后3 d（P<0.05），B组术后3 d、术后5 d的IL-6、TNF-α、Cor、NE水平低于A组（P<0.05）。B组的术后谵妄发生率较A组降低（P<0.05），两组不良反应发生率对比无差异（P>0.05）。B组术后6 h、术后12 h、术后24 h、术后48 h视觉模拟评分法（VAS）评分低于A组（P<0.05）。结论：老年腹腔镜胃癌根治术患者采用右美托咪定联合罗哌卡因TAPB可维持血流动力学稳定，减轻应激反应、炎症反应，降低术后谵妄发生率，术后镇痛效果良好，且安全性较好。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of dexmedetomidine combined with ropivacaine transversus abdominis plane block (TAPB) on stress response, inflammatory response and postoperative delirium in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer. Methods: 118 elderly patients who underwent laparoscopic radical gastrectomy in our hospital from July 2017 to October 2019 were selected, and randomly divided into group A (n=59, anesthesia with ropivacaine TAPB) and group B (n=59, anesthesia with dexmedetomidine combined with ropivacaine TAPB) according to the random envelope drawing. Hemodynamic indexes, stress response, inflammatory response, postoperative pain, postoperative delirium and incidence of adverse reactions were compared between two groups. Results: Heart rate (HR) and mean arterial pressure (MAP) of TAPB block from immediate (T1) to extubation (T4) time points in both groups were increased than those before anesthesia (P<0.05). HR and MAP in group B at T1~T4 time points were lower than those in group A (P<0.05). The levels of cortisol (Cor), norepinephrine (NE), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in both groups at 3 d after operation and 5 d after operation were higher than that before operation, bu 5 days after operation were lower than 3 days after operation (P<0.05). The levels of IL-6, TNF-α, Cor and NE in group B at 3 d after operation and 5 d after operation were lower than those in group A (P<0.05). The incidence of postoperative delirium in group B was lower than that in group A (P<0.05). There was no significant difference in the incidence of adverse reactions between two groups (P>0.05). The visual analogue scale (VAS) scores in group B were lower than those in group A at 6 h, 12 h, 24 h and 48 h after operation (P<0.05). Conclusion: In elderly patients undergoing laparoscopic radical gastrectomy, dexmedetomidine combined with ropivacaine TAPB can maintain hemodynamic stability, reduce stress response and inflammatory response, reduce postoperative delirium incidence, and achieve good postoperative analgesia effect and good safety. |
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