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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 262 -265. doi: 10.3877/cma.j.issn.1674-392X.2022.03.003

临床论著

罗哌卡因不同给药方式对老年腹股沟疝无张力修补术患者神经阻滞麻醉效果、镇痛及应激反应的影响
严益明1,†(), 秦玲1   
  1. 1. 243099　安徽省，马鞍山市人民医院麻醉科
  • 收稿日期:2021-12-06 出版日期:2022-06-20
  • 通信作者: 严益明
  • 基金资助:
    马鞍山市科技计划项目(YC-2015-08)

Effects of different administration methods of Ropivacaine on nerve block anesthesia, analgesia and stress response in elderly patients underwent tension-free inguinal hernia repair

Yiming Yan1,†(), Ling Qin1   

  1. 1. Department of Anesthesiology, Ma'anshan People's Hospital, Ma'anshan 243099, Anhui Province, China
  • Received:2021-12-06 Published:2022-06-20
  • Corresponding author: Yiming Yan
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严益明, 秦玲. 罗哌卡因不同给药方式对老年腹股沟疝无张力修补术患者神经阻滞麻醉效果、镇痛及应激反应的影响[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 262-265.

Yiming Yan, Ling Qin. Effects of different administration methods of Ropivacaine on nerve block anesthesia, analgesia and stress response in elderly patients underwent tension-free inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(03): 262-265.

目的

分析罗哌卡因不同给药方式对老年腹股沟疝无张力修补术患者神经阻滞麻醉效果、镇痛及应激反应的影响。

方法

选择2018年5月至2021年5月于马鞍山市人民医院收治的100例拟行无张力疝修补术的老年腹股沟疝患者作为研究对象，采用随机数字表法将患者分为2组，对照组（50例）采用将罗哌卡因广泛注射于手术区域，观察组（50例）在对照组的基础上进行罗哌卡因周围神经浸润麻醉。分析2组患者的心率、平均动脉压；检测2组患者的应激反应指标；对比2组患者的感觉阻滞起效时间、镇痛持续时间；评估2组患者的视觉模拟评分（VAS）、Ramsay评分；统计2组患者的并发症发生率。

结果

2组患者的心率、平均动脉压水平较麻醉前均有明显波动（P<0.05），但组间对比差异无统计学意义（P>0.05）。2组患者的血清白介素6、皮质醇、血糖水平较麻醉前均明显升高（P<0.05），但组间对比差异无统计学意义（P>0.05）。观察组患者的感觉阻滞起效时间明显低于对照组，镇痛持续时间明显高于对照组（P<0.05）。术后2、6 h，观察组患者的VAS评分明显低于对照组，Ramsay评分明显高于对照组（P<0.05）。观察组患者的并发症发生率为6.00%，稍高于对照组的4.00%（P>0.05）。

结论

罗哌卡因周围神经浸润麻醉可有效减轻无张力疝修补术患者的应激反应，加速麻醉起效时间，具有镇痛、镇静的作用，并发症发生率较低。

关键词: 罗哌卡因, 疝，腹股沟, 应激反应, 无张力疝修补术
Objective

To analyze the effects of different administration methods of ropivacaine on nerve block anesthesia, analgesia and stress response in elderly patients underwent tension-free inguinal hernia repair.

Methods

A total of 100 elderly patients with inguinal hernia undergoing tension-free hernia repair in Ma'anshan People's Hospital from May 2018 to May 2021 were selected as the research objects. The patients were divided into two groups by random number table method. The control group (50 cases) was widely injected with ropivacaine in the surgical area. The observation group (50 cases) received ropivacaine peripheral nerve infiltration anesthesia on the basis of the control group. The heart rate (HR) and mean arterial pressure (MAP) of patients in the two groups were analyzed. The stress response indicators of patients in the two groups were detected. The onset time of sensory block and analgesia duration of patients in the two groups were compared. The visual analogue score (VAS) and Ramsay score of patients in the two groups were evaluated, and the incidence of complications in the two groups was analyzed.

Results

After operation, HR and MAP levels in 2 groups fluctuated significantly compared with those before anesthesia (P<0.05). However, there was no statistical significance between 2 groups (P>0.05). The levels of serum IL-6, Cor and Glu in 2 groups were significantly higher than before anesthesia (P<0.05). However, there was no statistical significance between 2 groups (P>0.05). The onset time of sensory block in observation group was significantly shorter than that in control group, and the duration of analgesia were significantly longer than that in control group (P<0.05). At 2 h and 6h after operation, the VAS scores of observation group were significantly lower than those in the control group, Ramsay scores were significantly higher than control group (P<0.05). The complication rate in observation group was 6.00%, slightly higher than that in control group (4.00%) (P>0.05).

Conclusion

Ropivacaine peripheral nerve infiltration anesthesia can effectively reduce the stress response of patients with tension-free hernia repair, accelerate the effective time of anesthesia, have analgesic and sedative effects, and the incidence of complications is low.

Key words: Ropivacaine, Hernia, inguinal, Stress response, Tension-free herniorrhaphy
表1 2组患者HR、MAP水平比较（±s）
组别 例数 HR(次/min) MAP(mmHg)
麻醉前 术毕 麻醉前 术毕
观察组 50 67.24±3.25 73.16±2.28* 85.60±7.75 89.36±3.28*
对照组 50 67.52±3.69 73.64±2.66* 86.16±7.35 88.26±4.25*
t值   0.40 0.97 0.37 1.45
P值   0.69 0.34 0.71 0.15
表2 2组患者血清IL-6、Cor及血糖水平比较（±s）
组别 例数 IL-6(pg/ml) Cor(nmol/L) 血糖(mmol/L)
麻醉前 术毕 麻醉前 术毕 麻醉前 术毕
观察组 50 52.24±3.51 57.02±3.34* 302.68±30.14 319.72±23.83* 4.74±0.44 5.30±0.46*
对照组 50 52.28±3.55 58.16±3.11* 299.56±31.82 321.96±28.03* 4.72±0.45 5.38±0.73*
t值   0.06 1.77 0.50 0.43 0.22 0.66
P值   0.95 0.08 0.62 0.67 0.82 0.51
表3 2组患者VAS、Ramsay评分比较（分，±s）
组别 例数 VAS评分 Ramsay评分
术后2 h 术后6 h 术后2 h 术后6 h
观察组 50 2.24±0.43 1.42±0.50 2.86±0.67 2.06±0.24
对照组 50 2.58±0.50 1.66±0.48 2.20±0.40 1.76±0.43
t值   3.65 2.45 5.98 4.31
P值   0.00 0.02 0.00 0.00
表4 2组患者并发症发生率比较
组别 例数 恶心呕吐(例) 心律失常(例) 低血压(例) 尿潴留(例) 并发症发生率[例(%)]
观察组 50 0 1 1 1 3(6.00)*
对照组 50 0 1 1 0 2(4.00)
[1]
谢星彤, 梁龙. 腹横肌平面阻滞复合髂腹下髂腹股沟神经阻滞及切口局部浸润麻醉用于腹股沟疝手术老年患者的效果[J]. 河南外科学杂志, 2021, 27(1): 65-67.
[2]
律峰, 闵苏, 黎平, 等. 腰方肌阻滞用于老年患者单侧腹股沟斜疝修补术的效果[J]. 中华麻醉学杂志, 2019, 39(3): 369-372.
[3]
梁凌, 王敏, 钟爱群, 等. 不同比重布比卡因蛛网膜下腔阻滞麻醉对术后排尿功能、运动恢复的影响[J]. 中国药物经济学, 2019, 14(1): 51-54.
[4]
Qin C, Chen J, Shen Y. Individualized tension-free inguinal heria repair in elderly patients[J]. Minerva Chir, 2019, 74(3): 275-276.
[5]
陈宝霞, 林程程, 郑晓彬. 全身麻醉复合腰硬联合麻醉对腹腔镜手术患者术后疼痛程度与麻醉复苏的影响[J]. 中国医刊, 2020, 55(11): 1238-1241.
[6]
Sahin A, Ölcucuoglu E, Kulacoglu H. Crossing mesh tails in the Lichtenstein repair method for medial(direct) inguinal hernia: recurrence and chronic pain rates after five years[J]. Hernia, 2021, 25(5): 1231-1238.
[7]
Zhuang B, Yu K, Zhang ZW, et al. Application of totally visceral sac separation in abdominal wall hernia[J]. Zhonghua Yi Xue Za Zhi, 2021, 101(46): 3829-3832.
[8]
Ramsay G, Scott NW, Jansen JO. A 19 year population-based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs[J]. Hernia, 2020, 24(4): 793-800.
[9]
Khosravi F, Sadeghi N, Jarineshin H. The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal[J]. Eur J Clin Pharmacol, 2020, 76(7): 923-928.
[10]
李航宇, 顾岩, 王明刚, 等. 老年腹股沟疝诊断和治疗中国专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(8): 782-787.
[11]
周红娟, 肖春龙, 王波, 等. 不同麻醉方式对老年腹股沟疝无张力修补术患者麻醉效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(5): 502-505.
[12]
Aguilar-García J, Cano-González HA, Martínez-Jiménez MA, et al. Unilateral Lichtenstein tension-free mesh hernia repair and testicular perfusion: a prospective control study[J]. Hernia, 2018, 22(3): 479-482.
[13]
朱秀萍. 局部浸润和硬膜外麻醉用于老年腹股沟疝修补术的临床比较[J]. 浙江创伤外科, 2021, 26(1): 187-189.
[14]
石筱, 丁建英, 阎小军. 布比卡因蛛网膜下腔阻滞采用不同给药方式对瘢痕子宫剖宫产术产妇麻醉效果的观察[J]. 中国药物与临床, 2021, 21(18): 3144-3145.
[15]
朱振华. 布比卡因蛛网膜下腔阻滞不同给药方式对瘢痕子宫剖宫产产妇生理状态不良反应及新生儿的影响[J]. 基层医学论坛, 2020, 24(17): 2437-2438.
[16]
蔡少英. 不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜腹股沟疝修补术患者应激反应的影响[J]. 药品评价, 2020, 17(24): 30-34.
[17]
吴雄峰. 不同比重布比卡因蛛网膜下腔阻滞麻醉对下肢术后排尿功能,运动恢复影响的比较研究[J]. 临床合理用药杂志, 2020, 13(27): 113-115.
[18]
沈琦, 肖诗铭, 汪文明, 等. 布比卡因不同阻滞方式对无张力疝修补术的影响研究[J]. 重庆医学, 2021, 50(8): 1374-1376.
[19]
胡宇, 丁兆霞, 宋彦. 布比卡因蛛网膜下腔阻滞不同给药方式对于瘢痕子宫剖宫产产妇麻醉效果的影响[J]. 当代医学, 2020, 26(27): 166-168.
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