右美托咪定复合罗哌卡因在结直肠癌手术中应用探析

摘要/Abstract

摘要： 目的探讨右美托咪定复合罗哌卡因在结直肠癌手术患者腹横肌平面（transversus abdominis plane,TAP）阻滞中的应用价值。方法选择2019年1月~2021年12月金乡县人民医院收治的需在全麻下行结直肠癌手术患者72例作为研究对象,按随机数表法分为对照组（36例）、观察组（36例）。两组患者均在麻醉诱导后行TAP阻滞,其中对照组予以罗哌卡因,观察组给予右美托咪定复合罗哌卡因。对比两组镇痛效果[视觉模拟评分法（VAS）评分]、术后恢复情况、应激反应[血清皮质醇（Cor）、肾上腺素（E）]、炎症因子水平[肿瘤坏死因子α（TNF-α）、白介素6（IL-6）]及不良反应。结果观察组术后6 h、8 h、12 h、24 h静息时和活动时VAS评分低于对照组,术后麻醉苏醒、排气、排便、离床活动、住院时间短于对照组,差异有统计学意义（P<0.05）。麻醉前,两组Cor、E、TNF-α、IL-6相比,差异无统计学意义（P>0.05）;术后24 h,观察组Cor、E、TNF-α、IL-6低于对照组,差异有统计学意义（P<0.05）。两组不良反应相当,差异无统计学意义（P>0.05）。结论右美托咪定复合罗哌卡因用于结直肠癌手术患者TAP阻滞中可获得良好的镇痛效果,能够减轻机体应激反应及炎性反应,为患者术后恢复奠定良好基础,且安全性高,值得临床应用。

关键词: 结直肠癌, 右美托咪定, 罗哌卡因, 腹横肌平面阻滞, 应激反应

Abstract: Objective To investigate the value of dexmedetomidine combined with ropivacaine in transversus abdominis plane(TAP) block in patients undergoing colorectal cancer surgery. Methods A total of 72 patients with colorectal cancer undergoing general anesthesia in Jinxiang County People’s Hospital from January 2019 to December 2021 were selected as the research subjects, and were randomly divided into control group (36 cases) and observation group (36 cases). Both groups were treated with TAP block after anesthesia induction. The control group was treated with ropivacaine and the observation group was treated with dexmedetomidine combined with ropivacaine. The analgesic effect [visual analogue scale (VAS) score], postoperative recovery, stress response [serum cortisol (Cor), epinephrine (E)], inflammatory factor [tumor necrosis factor α (TNF-α), interleukin-6 (IL-6)] and adverse symptoms were compared between the two groups. Results The VAS scores of the observation group were lower than those of the control group at 6 h, 8 h, 12 h and 24 h after operation, and the anesthesia, exhaustion, defecation, out-of-bed activity and hospitalization time were shorter than those of the control group, the difference was statistically significant. (P<0.05); Before anesthesia, there was no statistically significant difference in Cor, E, TNF-α and IL-6 between the two groups (P>0.05); 24 hours after operation, Cor, E, TNF-α and IL-6 in the observation group were lower than those in the control group, the difference was statistically significant. (P<0.05); The adverse reactions of the two groups were similar, and there was no statistically significant difference (P>0.05). Conclusion Dexmedetomidine combined with ropivacaine for TAP block in patients with colorectal cancer surgery can obtain good analgesic effect, and alleviate the body stress reaction and inflammatory reaction, which may lay a good foundation for postoperative recovery, and high safety, worthy of clinical application.

Key words: colorectal cancer, dexmedetomidine, ropivacaine, transversus abdominis plane block, analgesia under general anesthesia, stress response

中图分类号:

R452

李慎占. 右美托咪定复合罗哌卡因在结直肠癌手术中应用探析[J]. 中华养生保健, 2022, 40(10): 4-7.

LI Shen-zhan. Application of Dexmedetomidine Combined with Ropivacaine in Colorectal Cancer Surgery[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(10): 4-7.

参考文献

[1] 唐芳,王娟.右美托咪定复合罗哌卡因腹横肌平面阻滞对结直肠癌根治术后镇痛效果的观察[J].蚌埠医学院学报,2021,46(9):1169-1172,1177.
[2] 蒋珏,黄燕.右美托咪定复合罗哌卡因行腹横肌平面阻滞对开腹手术术后疼痛及炎症反应的影响[J].现代中西医结合杂志,2020, 29(11):1228-1231.
[3] 季惠,李辉,季晓燕,等.超声引导下罗哌卡因腹横肌平面阻滞联合全凭静脉麻醉对腹部手术患者术中循环稳定性和术后疼痛程度的影响[J].中国医师杂志,2021,23(10):1552-1555.
[4] 吕蕾,陈蕾蕾,何菊萍.右美托咪啶混合罗哌卡因行腹横肌平面阻滞在经腔镜结直肠癌根治术全麻镇痛中的应用[J].中国医师杂志,2019,21(5):719-722,726.
[5] 胡建,许建峰,刘耿,等.右美托咪定不同给药方式复合腹横肌平面阻滞在结直肠肿瘤手术中的临床应用研究[J].现代医学,2020, 48(9):1117-1123.
[6] 国家卫生计生委医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017年版)[J].中华胃肠外科杂志,2018,21(1):92-106.
[7] 王静,吕凤云.中文版疼痛评估软件在老年术后患者中应用的信、效度分析[J].中华现代护理杂志,2017,23(34):4358-4362.
[8] Yamamoto T, Umegae S, Matsumoto K, et al.Peritoneal cytokines as early markers of peritonitis following surgery for colorectal carcinoma: a prospective study[J]. Cytokine, 2011, 53(2): 239-242.
[9] 杨坤渹,李扬,易勤美,等.超声引导下腹横肌平面阻滞联合右美托咪定对结直肠癌根治术的镇痛效果观察[J].海军医学杂志,2020, 41(3):323-325.
[10] 杨丽,孙广运,余得水.右美托咪定用于腹横筋膜阻滞对腹腔镜结直肠癌根治术患者术后谵妄的影响[J].四川医学,2020,41(5):449-453.
[11] 郭聪,杨昊.罗哌卡因复合不同剂量右美托咪定腹横肌平面阻滞对胃肠道腹腔镜手术患者镇痛及术后认知功能的影响[J].陕西医学杂志,2021,50(8):1011-1014.
[12] 马燕,李仲然,马开喜,等.右美托咪定复合罗哌卡因腹横肌平面阻滞对老年患者结直肠癌根治术后早期恢复质量的影响[J].临床麻醉学杂志,2020,36(2):148-151.
[13] 胡建,许建峰,刘耿,等.右美托咪定混合罗哌卡因腹横肌平面阻滞对腹腔镜下结直肠癌手术患者术后疼痛及免疫功能的影响[J].中国内镜杂志,2020,26(7):31-37.
[14] 陈涛,杜建龙,孙建良.右美托咪定复合罗哌卡因腹部筋膜阻滞对老年患者结肠癌术后镇痛效果的影响[J].中华老年医学杂志,2020, 39(6):672-675.
[15] 孙岸灵,惠强,陈思佳,等.右美托咪定超前镇痛联合腹横肌平面阻滞在结肠癌术后镇痛的适宜剂量探讨[J].海南医学院学报,2021, 27(16):1223-1228.