罗哌卡因局部浸润麻醉联合患者自控静脉镇痛在行腹腔镜胆囊切除术的老年患者中的应用

Application of local infiltration anesthesia combined with patient controlled intravenous analgesia with ropivacaine in elderly patients undergoing laparoscopic cholecystectomy

摘要:

目的 探讨罗哌卡因胆囊三角区局部浸润麻醉联合患者自控静脉镇痛（PCIA）在行腹腔镜胆囊切除术（LC）的老年患者中的应用，以及其对术后疼痛应激指标的影响。方法 回顾性分析2020年1月－2023年10月该院于全身麻醉下行LC的518例老年患者的临床资料，根据镇痛方案不同分为A组（n = 316）和B组（n = 202），A组采用罗哌卡因局部浸润麻醉联合PCIA，B组仅采用PCIA。比较两组患者围手术期麻醉指标、术后疼痛视觉模拟评分法（VAS）、术后Ramsay镇静评分、PCIA药物用量、血流动力学指标、疼痛应激因子［肾上腺素（AD）、去甲肾上腺素（NE）和皮质醇（Cor）］和术后24 h不良事件发生情况。结果 两组患者麻醉时间、苏醒时间、拔管时间和术中主要麻醉药物（右美托咪定、瑞芬太尼和苯磺顺阿曲库铵）用量比较，差异均无统计学意义（P > 0.05）；A组术后6、12和24 h静息VAS和动态VAS低于B组，A组术后12和24 h Ramsay镇静评分高于B组，差异均有统计学意义（P < 0.05）；A组术后24 h PCIA药物总用量和有效按压次数少于B组，差异均有统计学意义（P < 0.05）；两组患者经皮动脉血氧饱和度（SpO₂）水平比较，差异无统计学意义（P > 0.05），A组平均动脉压（MAP）、心率（HR）、AD、NE和Cor水平低于B组，差异均有统计学意义（P < 0.05）；两组患者术后24 h不良事件发生率比较，差异无统计学意义（P > 0.05）。结论 罗哌卡因局部浸润联合PCIA，可有效降低LC老年患者术后静息VAS和动态VAS，提高镇静效果，维持血流动力学平衡，抑制疼痛应激因子释放，且安全性较高。

Abstract:

Objective To explore the application of ropivacaine local infiltration anesthesia combined with patient controlled intravenous analgesia (PCIA) for postoperative analgesia and its influences on pain stress indexes in elderly patients after laparoscopic cholecystectomy (LC).Methods 518 elderly patients underwent LC under general anesthesia in the hospital were retrospectively enrolled from January 2020 to October 2023. According to different analgesia regimens, they were divided into group A (n = 316, ropivacaine local infiltration anesthesia combined with PCIA) and group B (n = 202, PCIA). The perioperative anesthesia indexes, scores of visual analogue scale (VAS) and Ramsay sedation after surgery, dosage of PCIA drug, hemodynamics, pain stress indexes [adrenaline (AD), norepinephrine (NE), cortisol (Cor)] and adverse events at 24 h after surgery were compared between the two groups.Results There were no differences in anesthesia time, recovery time, extubation time or intraoperative dosages of main anesthetics (dexmedetomidine, remifentanil and cisatracurium besilate) between the two groups (P > 0.05). Rest VAS and motion VAS in group A were lower than those in group B at 6, 12 and 24 h after surgery, Ramsay sedation scale were higher than those in group B at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05), dosage of PCIA drug and effective compression times were lower than those in group B at 24 h after surgery, the differences were statistically significant (P < 0.05). There was no difference in percutaneous arterial oxygen saturation (SpO₂) level between the two groups (P > 0.05). The levels of mean arterial pressure (MAP), heart rate (HR), AD, NE and Cor in group A were lower than those in group B, the differences were statistically significant (P < 0.05). There was no difference of adverse events rate between the two groups at 24 h after surgery (P > 0.05).Conclusion Ropivacaine Calot's triangle block combined with PCIA for postoperative analgesia can effectively reduce rest VAS and motion VAS, improve sedation effect, maintain hemodynamics balance and reduce levels of pain stress factors in elderly patients after LC, with good safety.