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*

Effects of Dexmedetomidine combined with Ropivacaine for transversus abdominis plane block on postoperative analgesia and immune function in patients underwent laparoscopic radical resection of colorectal cancer*

摘要:

摘要：目的??观察右美托咪定混合罗哌卡因行超声引导下腹横肌平面阻滞（TAPB）对腹腔镜下结直肠癌根治性切除术患者术后镇痛效果及免疫功能的影响。方法 选择择期行腹腔镜下结直肠癌根治性切除术的患者60例，随机分为右美托咪定混合罗哌卡因TAPB组（DR组）、单纯罗哌卡因TAPB组（R组）和生理盐水TAPB对照组（C组），每组20例。各组患者均于麻醉诱导后行超声引导下TAPB，DR组给予右美托咪定1μg/kg混合0.375%罗哌卡因共40?mL，R组给予0.375%罗哌卡因40?mL，C组注入生理盐水40?mL，每侧各20?mL。于术前（T0）、术后2 h（T1）、24 h（T4）和48 h（T5）时抽取静脉血样，采用流式细胞仪测定T淋巴细胞亚群（CD3+、CD4+和CD8+）和自然杀伤细胞（NK）水平；观察术后2?h（T1）、6?h（T2）、12?h（T3）、24?h（T4）和48?h（T5）的静息状态和运动状态下视觉模拟评分（VAS）；记录术中丙泊酚、瑞芬太尼用量、术后首次下床时间、肛门排气时间及住院天数。结果 与T0时比较，3组于T1、T4和T5时CD3+、NK细胞活性均明显降低（P?

Abstract:

Abstract: Objective?To observe the effects of Dexmedetomidine combined with Ropivacaine for transversus abdominis plane block on postoperative analgesia and immune function in patients underwent laparoscopic radical resection of colorectal cancer.?Methods?60 patients with colorectal cancer scheduled for elective laparoscopic radical colorectal resection were randomly divided into three groups (n?=?20 in each group): Dexmedetomidine mixed with Ropivacaine TAPB group (group DR), Ropivacaine TAPB group (group R) and control group (group C). Ultrasound guided bilateral TAPB was performed in all the patients after anesthesia induction, group DR with Dexmedetomidine 1 μg/kg plus 0.375% Ropivacaine to 40 mL and group R with 0.375% Ropivacaine 40 mL, equal volume of saline was used in group C. Venous blood samples were collected before induction (T0), 2 h after operation (T1), 24 h after operation (T4), 48 h after operation (T5) for detection of T lymphocyte subsets CD3+, CD4+, CD8+ and natural killer (NK) cells levels by flow cytometry. Visual analogue score (VAS) at rest and on movement at 2?h (T1), 6 h (T2), 12 h (T3), 24 h (T4) and 48 h (T5) after operation were assessed. The total consumption of Propofol and Remifentanil, the first off-bed time, the first flatus time, the length of postoperative hospital stay were also recorded.?Results?Compared with T0, the levels of CD3+, NK cells in three groups were significantly decreased at T1, T4, T5 (P?