摘要
目的:探讨右美托咪定复合罗哌卡因行腰方肌阻滞(QLB)对腹腔镜子宫肌瘤剔除术(LM)患者应激反应及术后康复的影响。方法:将2023年1-12月在本院妇产科收治的LM患者80例随机分成两组各40例,单一组行罗哌卡因QLB,联合组行右美托咪定复合罗哌卡因QLB。观察两组术后疼痛(VAS评分)、应激反应(皮质醇、去甲肾上腺素)、认知功能(MMSE评分)、睡眠质量(PSQI评分)、术后康复时间(排气、下床活动、住院)、不良反应(恶心呕吐、头晕、嗜睡、瘙痒)。结果:联合组术后2h、6h、12h、24hVAS评分(1.02±0.24分、1.63±0.48分、2.01±0.72分、3.06±0.70分)均低于单一组(1.15±0.36分、1.95±0.60分、2.62±0.85分、3.77±0.76分),两组术后24h皮质醇、去甲肾上腺素均升高但联合组(165.17±48.25 ng/ml、322.15±53.83 ng/L)低于单一组(189.25±51.03 ng/ml、345.23±45.90 ng/L),两组术后24h MMSE评分均降低、PSQI评分均升高,但联合组MMSE评分(27.05±1.19分)高于单一组(25.62±1.48分),PSQI评分(16.23±1.56分)低于单一组(18.00±1.68分),联合组术后排气(25.86±5.12 h)、下床活动(1.88±0.69 d)、住院时间(6.01±1.60 d)均短于单一组(33.57±6.34 h、2.65±0.75 d、7.32±1.78 d)(均P<0.05),不良反应发生率(15.0%)与单一组(12.5%)无差异(P>0.05)。结论:右美托咪定复合罗哌卡因行QLB在LM麻醉效果较好,可减轻患者术后疼痛及应激反应,改善认知功能与睡眠质量,利于术后康复,具有用药安全性。
Objective:To investigate the effects of dexmedetomidine combined with ropivacaine for quadratus lumborum block(QLB)during laparoscopic myomectomy(LM)of patients on their stress and postoperative recovery.Methods:80 patients who wanted LM admitted to the obstetrics and gynecology department of the hospital were randomly divided into group A and group B(40 patients in each group)from January 2023 to December 2023.The patients in group A were given ropivacaine for QLB,while the patients in group B given dexmedetomidine combined with ropivacaine for QLB.The postoperative pain evaluated by VAS score,the levels of stress response indicatiors,such as cortisol and norepinephrine,the cognitive function evaluated by MMSE score,the sleep quality evaluated by PSQI score,the time of postoperative recovery,such as the exhaust time,the time of getting out of bed and the duration of hospitalization stay,and the situation of adverse reactions,such as nausea and vomiting,dizziness,drowsiness and itching,of the patients in the two groups were observed.Results:The VAS scores of the patients in group B at 2h,6h,12h and 24h after operation(1.02±0.24 points,1.63±0.48 points,2.01±0.72 points and 3.06±0.70 points)were significantly lower than those(1.15±0.36 points,1.95±0.60 points,2.62±0.85 points and 3.77±0.76 points)of the patients in group A.The levels of cortisol and norepinephrine of the patients in both groups at 24 hours after operation had increased significantly,but which(165.17±48.25 ng/ml and 322.15±53.83 ng/L)of the patients in group B were significantly lower than those(189.25±51.03 ng/ml and 345.23±45.90 ng/L)of the patients in group A.The MMSE score of the patients in both groups at 24 hours after operation had decreased significantly and the PSQI score of the patients in both groups at 24 hours after operation had increased significantly,but the MMSE score(27.05±1.19 points)of the patients in group B was significantly higher than that(25.62±1.48 points)of the patients in group A and the PSQI score(16.23±1.56 points)of the patients in group B was significantly lower than that(18.00±1.68 points)of the patients in group A.The time of the postoperative exhaust(25.86±5.12 h),the time of getting out of bed(1.88±0.69 d)or the duration of hospital stay(6.01±1.60 d)of the patients in group B was significantly shorter than that(33.57±6.34h,2.65±0.75 d or 7.32±1.78 d)of the patients in group A(all P<0.05).There was no significant difference in the incidence of the adverse reactions(15.0%vs.12.5%)of the patients between the two groups(P>0.05).Conclusion:The combination of dexmedetomidine and ropivacaine for QLB during LM of the patients has better anesthetic effect,and can reduce the postoperative pain and stress reactions,improve the cognitive function and the sleep quality of the patients,and which is beneficial for the postoperative recovery with the safety of medicine.
作者
齐佳奇
张子栋
居艳梅
高洁
王晋平
QI jiaqi;ZHANG Zidong;JU Yanmei;GAO Jie;WAMG Jinping(Postgraduate Training Base of Jinzhou Medical University(Jincheng People's Hospital of Shanxi Province),Jincheng,Shanxi Province,048026;The Eighth People's Hospital of Hengshui,Hebei Province)
出处
《中国计划生育学杂志》
2024年第6期1331-1335,共5页
Chinese Journal of Family Planning
