切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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)
[1]
胡海斌. 补中益气汤辅助无张力疝气修补术治疗腹股沟疝患者的临床观察[J]. 中国民间疗法, 2020, 28(7): 51-53.
[2]
陈新桃, 魏淑英. 右美托咪定复合罗哌卡因腹横肌平面阻滞在腹股沟疝修补术中的临床效果[J]. 现代诊断与治疗, 2020, 31(7): 1084-1086.
[3]
Shin HJ, Do SH, Lee JS, et al. Comparison of intraoperative sedation with dexmedetomidine versus propofol on acute postoperative pain in total knee arthroplasty under spinal anesthesia: a randomized trial[J]. Anesth Analg, 2019, 129(6): 1512-1518.
[4]
Kang R, Jeong JS, Yoo JC, et al. Effective dose of intravenous dexme-detomidine to prolong the analgesic duration of interscalene brachial plexus block: a single-center, prospective, double-blind, randomized controlled trial[J]. Reg Anesth Pain Med, 2018, 43(5): 488-495.
[5]
杨淼, 方华, 章放香, 等. 七氟醚麻醉下右美托咪定复合罗哌卡因行髂腹下/髂腹股沟神经阻滞的效果[J]. 临床麻醉学杂志, 2017, 33(9): 872-874.
[6]
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.
[7]
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.
[8]
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.
[9]
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.
[10]
Fatemeh K, Niloofar S, Hashem J. 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.
[11]
谭珊珊, 朱诗瑶, 朱珊珊, 等. 右美托咪啶联合罗哌卡因腹横肌平面阻滞在腹股沟疝修补术中应用的效果观察[J]. 中国医师杂志, 2019, 21(5): 758-761.
[12]
石晶晶, 董河. 重度子痫前期孕妇与健康孕妇在腰硬联合麻醉下行剖宫产术发生低血压的风险比较[J]. 河北医学, 2018, 24(1): 16-20.
[13]
王府, 陈莹璐, 张亮. 右美托咪定不同给药途径对区域麻醉局麻药协同作用影响的研究进展[J]. 中国药房, 2019, 30(16): 2297-2304.
[14]
Bao N, Tang B. Organ-protective effects and the underlying mechanism of dexmedetomidine[J]. Mediators Inflamm, 2020, 2020(1): 1-11.
[15]
杨铎, 张隆盛, 陈哲璇, 等. 右美托咪定对罗哌卡因前锯肌平面阻滞半数有效浓度的影响[J]. 临床麻醉学杂志, 2021, 37(10): 1029-1033.
[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]
张佳雷, 张文斌. 右美托咪定对罗哌卡因半数有效浓度的影响[J/OL]. 中华关节外科杂志(电子版), 2021, 15(2): 239-242.
[18]
Gu XX, Tan XJ, Chen JX, et al. The clinical effect of dexmedetomidine combined with parecoxib sodium on sedation, antianxiety and prevention of intubation stress in patients undergoing functional endoscopic sinus surgery: a randomised controlled trial[J]. BMC Anesthesiol, 2020, 20(1): 166.
[19]
赵楠楠, 李海, 时迎斌, 等. 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胆囊切除术患者镇痛效果研究[J]. 中国医刊, 2021, 56(7): 775-778.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[11] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[12] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[13] 李博, 胡刚, 邱文龙, 汤坚强, 王锡山. 多功能吲哚菁绿近红外荧光血管成像技术在腹腔镜直肠癌经自然腔道取标本手术（NOSES Ⅳ式）中的应用（附视频）[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 524-528.
[14] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
[15] 黄泽辉, 梁杰贤, 曾伟. 右美托咪定联合艾司氯胺酮在小儿无痛胃镜检查中的应用研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 510-513.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号