罗哌卡因腹横肌平面阻滞对腹腔镜子宫肌瘤剔除术患者镇痛效果及应激反应的影响

Effect of Ropivacaine transversus abdominis plane block on analgesic effect and stress response of patients underwent laparoscopic hysteromyomectomy

摘要:

目的 探讨罗哌卡因腹横肌平面（TAP）阻滞对腹腔镜子宫肌瘤剔除术患者镇痛效果及应激反应的影响。方法 选取2019年10月－2020年5月于该院行腹腔镜子宫肌瘤剔除术的患者90例作为研究对象，采用随机数字表法分为A组（n = 45）和B组（n = 45）。A组在术毕实施静脉镇痛，B组在麻醉诱导时采用罗哌卡因TAP阻滞。对比两组麻醉效果、麻醉药物用量、不良反应发生情况、围术期各时点心率（HR）、平均动脉压（MAP）、应激反应指标［血糖（Glu）、去甲肾上腺素（NE）、皮质醇（Cor）］水平以及术后各时点疼痛程度。结果 B组麻醉唤醒时间、恢复自主呼吸时间和拔管时间均明显短于A组（P < 0.01）。A组和B组舒芬太尼用量分别为（31.26±6.35）和（21.18±2.54）μg，七氟醚用量分别为（35.63±7.65）和（25.33±5.06）mL，两组麻醉药物用量比较，差异有统计学意义（t = 9.89和7.53，均P < 0.01）。B组切皮前（T₁）、切皮后5 min（T₂）、切皮后10 min（T₃）HR和MAP均明显低于A组（P < 0.01）。B组T₁、T₂、T₃和T₄时点血浆Glu、NE和Cor水平均明显低于A组（P < 0.01）。B组术后2、4和12 h的视觉模拟评分（VAS）均明显低于A组（P < 0.01）。A组和B组术后不良反应发生率（33.33%和13.33%）比较，差异有统计学意义（􀱽² = 5.03，P = 0.025）。结论 罗哌卡因TAP阻滞能够减轻腹腔镜下子宫肌瘤剔除术患者术中应激反应，提高麻醉效果，并降低术后不良反应发生率。

Abstract:

Objective To explore the effect of Ropivacaine transversus abdominis plane block (TAP) block on analgesic effect and stress response in patients underwent laparoscopic hysteromyomectomy.Methods 90 patients underwent laparoscopic hysteromyomectomy from October 2019 to May 2020 were selected as the study subjects. The random digital table method was used to divide patients into A group (n = 45) and B group (n = 45). Group A performed intravenous analgesia after operation, Ropivacaine was used for TAP block during anesthesia induction in group B. The effects of anesthesia, dosage of anesthetic drugs, occurrence of adverse reactions, heart rate (HR), mean arterial pressure (MAP) and stress response index [plasma of glucose (Glu), norepinephrine (NE), cortisol (Cor)] were compared between the two groups. degree of pain at each time point after operation were compared between the two groups.Results The arousal time, recovery time of spontaneous respiration and extubation time were significantly lower than that in group A (P < 0.01). The doses of Sufentanil in group A and B were (31.26 ± 6.35) and (21.18 ± 2.54) μg, and the doses of Sevoflurane were (35.63 ± 7.65) and (25.33 ± 5.06) mL, respectively. The difference in dosage was statistically significant (t = 9.89, 7.53, P < 0.01). The levels of HR and MAP in group B before skin incision (T₁), 5 min after skin incision (T₂), and 10 min after skin incision (T₃) were significantly lower than those in group A (P < 0.001). The plasma levels of Glu, NE and Cor at T₁, T₂, T₃ and T₄ in group B were significantly lower than those in group A (P < 0.01). There was significant difference between group A and group B (33.33% vs 13.33%) (􀱽² = 5.03, P = 0.025).Conclusion Ropivacaine combined with TAP block can reduce the intraoperative stress response of patients underwent laparoscopic myomectomy, improve the anesthetic effect, and reduce the incidence of postoperative adverse reactions.