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腹横肌平面阻滞联合小剂量右美托咪定对老年腹腔镜结肠切除术患者的影响。

Effect of transversus abdominis plane block combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy.

作者信息

Zhang Zhanjun, Hao Danning

机构信息

Department of Anesthesiology, Jaozuo People's Hospital, Jaozuo, Henan Province, China.

出版信息

Wideochir Inne Tech Maloinwazyjne. 2023 Sep;18(3):524-532. doi: 10.5114/wiitm.2023.128713. Epub 2023 Jun 16.

Abstract

INTRODUCTION

Colon cancer is a common malignancy, for which surgery is currently the preferred therapy.

AIM

To assess the effect of transversus abdominis plane block (TAPB) combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy.

MATERIAL AND METHODS

Sixty-two elderly patients undergoing laparoscopic colectomy between March 2021 and March 2022 were randomly selected and equally divided into Group A (low-dose dexmedetomidine) and Group B (TAPB + low-dose dexmedetomidine) by the randomized double-blind method. The treatment outcomes were compared.

RESULTS

The resting and active Visual Analogue Scale and Pittsburgh Sleep Quality Index scores were lower in Group B than those in Group A at 6 h, 1 day, 2 days and 3 days after operation (p < 0.05). The two groups had no significant differences in the levels of cluster of differentiation 4+ (CD4+), CD8+ and free Cor, CD4+/CD8+ ratio and NK cell level before anesthesia (p > 0.05). At 24 h after the operation, the level of CD4+, CD4+/CD8+ ratio and NK cell level were higher in Group B than those in Group A, and the levels of CD8+ and free Cor were lower in Group B (p < 0.05). Group B had higher partial pressure of oxygen ((45.52 ±11.14) mm Hg) and pH (7.42 ±0.06) (p < 0.05) and lower partial pressure of carbon dioxide ((4.05 ±0.32) mm Hg) than those of Group A (p < 0.05).

CONCLUSIONS

TAPB combined with low-dose dexmedetomidine can exert better anesthetic, analgesic and sedative effects, and ameliorate stress responses.

摘要

引言

结肠癌是一种常见的恶性肿瘤,目前手术是其首选治疗方法。

目的

评估腹横肌平面阻滞(TAPB)联合低剂量右美托咪定对老年腹腔镜结肠切除术患者的影响。

材料与方法

随机选取2021年3月至2022年3月期间行腹腔镜结肠切除术的62例老年患者,采用随机双盲法将其平均分为A组(低剂量右美托咪定)和B组(TAPB + 低剂量右美托咪定)。比较两组的治疗效果。

结果

术后6小时、1天、2天和3天,B组的静息和活动视觉模拟量表评分及匹兹堡睡眠质量指数评分均低于A组(p < 0.05)。两组麻醉前分化簇4 +(CD4 +)、CD8 +和游离皮质醇水平、CD4 + / CD8 +比值及自然杀伤细胞水平差异无统计学意义(p > 0.05)。术后24小时,B组的CD4 +水平、CD4 + / CD8 +比值及自然杀伤细胞水平高于A组,CD8 +和游离皮质醇水平低于A组(p < 0.05)。B组的氧分压((45.52 ± 11.14)mmHg)和pH值(7.42 ± 0.06)高于A组(p < 0.05),二氧化碳分压((4.05 ± 0.32)mmHg)低于A组(p < 0.05)。

结论

TAPB联合低剂量右美托咪定可发挥更好的麻醉、镇痛和镇静作用,并改善应激反应。

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