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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) : 282 -285. doi: 10.3877/cma.j.issn.1674-392X.2022.03.008

临床论著

右美托咪定复合罗哌卡因对腹腔镜疝修补术老年患者神经阻滞效果的影响
方辉强1, 黄杰1,†(), 何国安1, 罗云1, 何彦菲1   
  1. 1. 242300　安徽省宁国市人民医院麻醉科
  • 收稿日期:2021-06-15 出版日期:2022-06-20
  • 通信作者: 黄杰
  • 基金资助:
    宣城市科技计划项目(2139)

Effect of dexmedetomidine combined with ropivacaine on nerve block in elderly patients undergoing laparoscopic inguinal hernia repair

Huiqiang Fang1, Jie Huang1,†(), Guoan He1, Yun Luo1, Yanfei He1   

  1. 1. Department of Anesthesiology, Ningguo People's Hospital, Xuancheng 242300, Anhui Province, China
  • Received:2021-06-15 Published:2022-06-20
  • Corresponding author: Jie Huang
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引用本文：

方辉强, 黄杰, 何国安, 罗云, 何彦菲. 右美托咪定复合罗哌卡因对腹腔镜疝修补术老年患者神经阻滞效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 282-285.

Huiqiang Fang, Jie Huang, Guoan He, Yun Luo, Yanfei He. Effect of dexmedetomidine combined with ropivacaine on nerve block in elderly patients undergoing laparoscopic inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(03): 282-285.

目的

分析右美托咪定复合罗哌卡因对腹腔镜下行腹股沟疝修补术老年患者神经阻滞效果的影响。

方法

选择2019年12月至2020年12月于宁国市人民医院普外科收治的66例拟行腹股沟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，每组患者33例。对照组采用罗哌卡因，观察组采用右美托咪定复合罗哌卡因。分析2组患者的心率（HR）、平均动脉压（MAP），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组患者的疼痛视觉模拟评分（VAS）、Ramsay评分，统计2组患者的并发症发生率。

结果

术毕，观察组的HR水平明显低于对照组，MAP水平明显高于对照组（P<0.05）；观察组的白介素6、皮质醇、血糖水平明显低于对照组（P<0.05）。观察组的镇痛持续时间明显高于对照组，感觉阻滞起效时间明显低于对照组（P<0.05）。术后2、6 h，观察组的Ramsay评分明显高于对照组，VAS评分明显低于对照组（P<0.05）。观察组的并发症发生率为15.15%，稍低于对照组的18.18%（P>0.05）。

结论

右美托咪定复合罗哌卡因可有效维持腹腔镜腹股沟疝修补术老年患者的血流动力学稳定，并减轻其应激反应，加速麻醉起效时间。

关键词: 右美托咪定, 罗哌卡因, 腹腔镜, 疝，腹股沟
Objective

To analyze the effect of dexmedetomidine combined with ropivacaine on nerve block in elderly patients undergoing laparoscopic inguinal hernia repair.

Methods

66 elderly patients with inguinal hernia admitted in general surgery of Ningguo city people's hospital from December 2019 to December 2020 were selected as the research subjects. The patients were divided into two groups using the random number table method: control group (33 cases) was given ropivacaine, observation group (33 cases) was given dexmedetomidine combined with ropivacaine. The heart rate (HR), 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 analog score (VAS) score and Ramsay score of patients in the two groups were evaluated, and the incidence of complications of patients in the two groups were analyzed.

Results

After operation, HR level in the observation group were significantly lower than that in the control group, and MAP level was significantly higher than that in the control group (P<0.05). The levels of IL-6, Cor and Glu in the observation group were significantly lower than those in the control group (P<0.05). The duration of analgesia in the observation group was significantly longer than that in the control group, and the onset time of sensory block was significantly shorter than that in the control group (P<0.05). At 2 h and 6h after surgery, Ramsay score in the observation group was significantly higher than that in the control group, and VAS score was significantly lower than that in the control group (P<0.05). The complication rate in the observation group was 15.15%, which was slightly lower than 18.18% in the control group (P>0.05).

Conclusion

Dexmedetomidine combined with ropivacaine can effectively maintain the hemodynamic stability of elderly patients undergoing laparoscopic inguinal hernia repair, reduce their stress response, accelerate the onset time of anesthesia.

Key words: Dexmedetomidine, Ropivacaine, Laparoscopes, Hernia, inguinal
表1 2组患者心率和平均动脉压水平比较（±s）
组别 例数 心率(次/min) 平均动脉压(mmHg)
麻醉前 术毕 麻醉前 术毕
观察组 33 67.45±3.51 73.30±2.23* 105.48±7.44 99.21±3.37*
对照组 33 67.33±3.31 75.27±2.11* 106.73±7.36 96.36±3.27*
t值   0.14 3.69 0.69 3.49
P值   0.89 <0.001 0.50 <0.001
表2 2组患者患白介素6、皮质醇及血糖水平比较（±s）
组别 例数 白介素6(pg/ml) 皮质醇(nmol/L) 血糖(mmol/L)
麻醉前 术毕 麻醉前 术毕 麻醉前 术毕
观察组 33 52.21±3.47 56.88±3.16* 305.52±30.55 319.21±23.46* 4.73±0.45 5.33±0.48*
对照组 33 52.30±3.31 59.48±3.02* 303.85±32.37 334.76±24.20* 4.70±0.47 5.76±0.44*
t值   0.11 3.42 0.22 2.65 0.26 3.79
P值   0.91 <0.001 0.83 0.01 0.79 <0.001
表3 2组患者感觉阻滞起效时间及镇痛持续时间比较（min，±s）
组别 例数 感觉阻滞起效时间 镇痛持续时间
观察组 33 10.84±1.00 803.07±108.67
对照组 33 11.86±1.22 739.10±128.35
t值   3.71 2.19
P值   <0.001 0.03
表4 2组患者疼痛量表、Ramsay评分比较（±s）
组别 例数 视觉模拟评分 Ramsay评分
术后2 h 术后6 h 术后2 h 术后6 h
观察组 33 2.21±0.42 1.39±0.50 2.85±0.67 2.09±0.29
对照组 33 2.61±0.50 1.64±0.49 2.21±0.42 1.73±0.45
t值   3.52 2.08 4.65 3.86
P值   <0.001 0.04 <0.001 <0.001
表5 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) 合计[例(%)]
观察组 33 2 1 1 1 5(15.15)a
对照组 33 4 1 1 0 6(18.18)
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