右美托咪定-罗哌卡因腹横肌平面阻滞对结直肠癌手术镇痛及认知功能障碍风险的影响
Effect of dexmedetomidine-ropivacaine transversus abdominis plane block on analgesia and cognitive impairment risk in colorectal cancer surgery.
作者信息
Zhang Xing, Xiang Guang-Rong, Wang Zhi-Xin, Peng Ming-Qing, Li Min
机构信息
Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China.
Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing 400014, China.
出版信息
World J Gastrointest Surg. 2025 Jun 27;17(6):102907. doi: 10.4240/wjgs.v17.i6.102907.
BACKGROUND
The dexmedetomidine (DEX) plus ropivacaine treatment enables a transversus abdominis plane block (TAPB) of the peripheral nerves in patients undergoing radical resection for colorectal cancer (CRC) that can provide clinical data for improving the postoperative analgesic effect, reducing the risk of cognitive impairment, and decreasing the circulating levels of serum inflammatory factors and stress hormones.
AIM
To assess the impact of DEX plus ropivacaine-enabled TAPB on pain, postoperative cognitive dysfunction (POCD), and inflammatory/stress factors.
METHODS
Our patient cohort was randomly divided into control and observation groups (60/group). The observation group used a DEX plus ropivacaine-enabled TAPB, while the control group employed a ropivacaine-enabled TAPB. The pain score [Visual Analogy Scale (VAS), Montreal Cognitive Assessment (MoCA)], serum inflammatory factor level (C-reactive protein, interleukin-6 and tumor necrosis factor-α), serum stress hormone levels (cortisol and adrenaline) and postoperative adverse reactions were compared between the two groups.
RESULTS
The observation group VAS scores were lower than those of the control group (better analgesic effect, < 0.05). The MoCA and POCD scores decreased post-surgery in the observation group ( < 0.05). In the elderly, the overall VAS and MoCA scores were significantly reduced compared with the young group. The C-reactive protein, interleukin-6, tumor necrosis factor-α, cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery ( < 0.05). There was no significant difference in adverse reactions between the two groups post-surgery, but the incidence of adverse reactions in the observation group was still lower. DEX continuously inhibited p65-phosphorylation levels in the nuclear factor κB pathway at multiple time points, and its inhibitory effect became more significant over time.
CONCLUSION
DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels, and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.
背景
右美托咪定（DEX）联合罗哌卡因用于接受结直肠癌（CRC）根治性切除术患者的外周神经腹横肌平面阻滞（TAPB），可为改善术后镇痛效果、降低认知功能障碍风险以及降低血清炎症因子和应激激素的循环水平提供临床数据。
目的
评估DEX联合罗哌卡因的TAPB对疼痛、术后认知功能障碍（POCD）及炎症/应激因子的影响。
方法
将患者队列随机分为对照组和观察组（每组60例）。观察组采用DEX联合罗哌卡因的TAPB，而对照组采用罗哌卡因的TAPB。比较两组的疼痛评分[视觉模拟评分法（VAS）、蒙特利尔认知评估量表（MoCA）]、血清炎症因子水平（C反应蛋白、白细胞介素-6和肿瘤坏死因子-α）、血清应激激素水平（皮质醇和肾上腺素）以及术后不良反应。
结果
观察组的VAS评分低于对照组（镇痛效果更好，P<0.05）。观察组术后MoCA和POCD评分降低（P<0.05）。与年轻组相比，老年患者的总体VAS和MoCA评分显著降低。术后观察组的C反应蛋白、白细胞介素-6、肿瘤坏死因子-α、皮质醇和肾上腺素水平低于对照组（P<0.05）。两组术后不良反应无显著差异，但观察组的不良反应发生率仍较低。DEX在多个时间点持续抑制核因子κB途径中的p65磷酸化水平，且其抑制作用随时间推移变得更加显著。
结论
DEX联合罗哌卡因的TAPB可降低POCD以及炎症/应激激素水平，并显著改善接受结直肠癌根治性切除术患者的术后镇痛效果。
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