摘要
目的:探讨不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞(TAPB)对腹腔镜腹股沟疝修补术患者免疫炎症反应和认知功能的影响。方法:根据随机数字表法将2020年3月至2022年3月期间合肥市第二人民医院收治的150例腹腔镜腹股沟疝修补术患者分为A组(n=75)、B组(n=75)。两组均采用右美托咪定联合罗哌卡因TAPB,A组给予0.5μg/kg右美托咪定,B组给予1μg/kg右美托咪定。对比两组血流动力学、视觉模拟评分(VAS)、简易智能状态检查量表(MMSE)评分、术后认知功能障碍(POCD)发生率、炎症反应、免疫功能相关指标。结果:与A组手术开始时1 h(T1)、手术结束即刻(T2)时间点相比,B组平均动脉压(MAP)、心率(HR)更低(P<0.05)。B组POCD发生率低于A组(P<0.05)。与A组术后1 d、术后2 d相比,B组MMSE评分更高(P<0.05)。与A组术后12 h、术后24 h、术后48 h相比,B组VAS评分更低(P<0.05)。与A组术后2 d相比,CD8P更低,B组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)更高(P<0.05)。与A组术后2 d相比,B组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)更低(P<0.05)。结论:腹腔镜腹股沟疝修补术患者采用1μg/kg剂量右美托咪定联合罗哌卡因TAPB麻醉,可减轻疼痛感,缓解免疫炎症反应程度,维持血流动力学稳定,同时还可降低POCD发生率。
Objective:To investigate the effects of different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block(TAPB)on immune inflammatory response and cognitive function in patients undergoing laparoscopic inguinal hernia repair.Methods:150 patients with laparoscopic inguinal hernia repair who were admitted to the Second People's Hospital of Hefei from March 2020 to March 2022 were divided into group A(n=75)and group B(n=75)according to the random number table method.Both groups were treated with dexmedetomidine combined with ropivacaine TAPB,group A was given 0.5μg/kg dexmedetomidine and group B was given 1μg/kg dexmedetomidine.The hemodynamics,visual analogue scale(VAS),mini-mental state examination(MMSE)score,incidence of postoperative cognitive dysfunction(POCD),inflammatory response and immune function related indicators were compared in two groups.Results:Compared with group A at the beginning of operation 1 h(T1)and immediately after the end of operaion(T2),mean arterial pressure(MAP)and heart rate(HR)were lower in group B(P<0.05).The incidence of POCD in group B was lower than that in group A(P<0.05).Compared with group A 1 d and 2 d after operation,the MMSE score in group B was higher(P<0.05).Compared with group A at 12 h,24 h and 48 h after operation,the VAS score in group B was lower(P<0.05).Compared with group A 2 d after operation,CD8+was lower,and CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) were higher in group B(P<0.05).Compared with group A 2 d after operation,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)were lower in group B(P<0.05).Conclusion:Anesthesia with 1μg/kg dose of dexmedetomidine combined with ropivacaine TAPB in patients undergoing laparoscopic inguinal hernia repair,which can reduce pain,alleviate the degree of immune inflammatory response,maintain hemodynamic stability,and reduce the incidence of POCD.
作者
涂茂勇
何文胜
张应涛
丁盼盼
陈帝豪
TU Mao-yong;HE Wen-sheng;ZHANG Ying-tao;DING Pan-pan;CHEN Di-hao(Department of Anesthesiology,The Second People's Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei,Anhui,230011,China)
出处
《现代生物医学进展》
CAS
2024年第9期1773-1777,共5页
Progress in Modern Biomedicine
基金
安徽省自然科学基金项目(1908085MH256)。
