罗哌卡因辅助地佐辛浸润麻醉对幕上肿瘤切除术患者的麻醉效果

Efficacy of ropivacaine-assisted dezocine for infiltration anesthesia in patients undergoing supratentorial tumor resection

摘要:

目的 观察罗哌卡因辅助地佐辛麻醉对幕上肿瘤切除术患者麻醉恢复情况及恢复期应激反应的影响。方法 选取2017年3月至2019年5月四川省内江市第二人民医院麻醉科接受幕上肿瘤切除术患者60例,按随机数表法分为研究组和对照组,各组30例。2组患者均采取全身麻醉。对照组于切皮前10min予以生理盐水20ml浸润麻醉,术毕前30min静注10mg地佐辛；研究组于切皮前10min予以罗哌卡因浸润麻醉,术毕前30min静注10mg地佐辛。对比2组患者麻醉前(T₀)、术毕时(T₁)、拔管即刻(T₂)、拔管后30min(T₃)的心率(HR)、舒张压(DBP)、收缩压(SBP)、应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu)]水平,并比较2组患者低血压发生率、血管活性药物使用情况、麻醉恢复情况、不良反应发生率、麻醉苏醒期镇静评分(SAS)、疼痛程度评分(VAS)。采用SPSS 23.0统计软件进行分析。根据数据类型,组间比较采用t检验或卡方检验。结果 T₀时,2组患者HR、DBP、SBP、E、NE、Cor、Glu水平相比差异无统计学意义(P＞0.05)。在T₁、T₂、T₃时,研究组上述指标均低于对照组(P＜0.05)。与T₀相比,研究组T₁、T₂、T₃时上述指标变化不明显(P＞0.05),但对照组变化较明显,差异有统计学意义(P＜0.05)。对照组和研究组分别发生低血压20.00%(6/30)和6.67%(2/30),2组低血压发生率比较差异无统计学意义(χ²=1.298,P=0.255)。对照组使用血管活性药物NE、多巴胺、麻黄碱的患者有4、4、10例,研究组依次有0、2、2例。2组患者使用血管活性药物构成比比较,差异有统计学意义(χ²=6.667,P=0.010)。与对照组比较,研究组气管拔管时间[(15.41±3.20)和(24.02±4.93)min,t=8.024,P＜0.001]、麻醉恢复时间[(10.67±3.38)和(15.24±4.26)min,t=4.603,P＜0.001]显著缩短,镇痛效果持续时间[(11.73±1.59)和(7.91±1.28)h,t=10.250,P＜0.001]显著延长,麻醉苏醒期SAS[(3.82±0.41)和(5.06±0.50)分,t=10.504,P＜0.001]、VAS[(2.25±0.21)和(4.30±0.36)分,t=26.941,P＜0.001]评分、以及不良反应发生率[10.00%(3/30)和33.33%(10/30),χ²=4.812,P=0.028]显著降低,差异均有统计学意义。结论 罗哌卡因辅助地佐辛麻醉应用于幕上肿瘤切除术患者可促进麻醉后恢复,稳定恢复期血流动力学,减轻恢复期应激反应,提升镇静、镇痛效果,减少不良反应发生。

Abstract:

Objective To determine the effect of ropivacaine-assisted dezocine anesthesia on recovery and stress responses during the period in patients undergoing supratentorial tumor resection. Methods Sixty patients undergoing supratentorial tumor resection in our hospital from March 2017 to May 2019 were recruited in this study. They were randomly divided into study group (n=30) and control group (n=30). All groups were treated with general anesthesia. The patients of the control group received 20 ml of saline infiltration in 10min before incision, and intravenous injection of 10mg dezocine in 30min before the end of surgery. While, those of the study group received ropivacaine infiltration and 10mg dezocine at the same time points, respectively. The heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), levels of agonistic indices, including epinephrine (E), norepinephrine (NE), cortisol (Cor), glucose (Glu) before anesthesia (T₀), end of the operation (T₁), extubation immediately (T₂), and 30min after extubation (T₃) were compared between the 2 groups. The incidence rate of hypotension, usage of vasoactive drugs, anesthesia recovery, incidence of adverse reactions, anesthesia recovery sedation-agitation scale (SAS), pain degree score (visual analogue scale, VAS) were also recorded and compared. SPSS statistics 23.0 was used for analysis. According to the data types, Student′s t test or Chi-square test was applied forcomparison between two groups. Results At T₀, there were no significant differences in HR, DBP, SBP, and levels of E, NE, Cor and Glu between the 2 groups (P>0.05). At T₁, T₂ and T₃, the above indices in the study group were lower than those in the control group (P<0.05). Compared with T₀, no significant changes were observed in the above indices at T₁, T₂ and T₃ in the study group (P>0.05), but obvious changes were seen in the control group (P<0.05). The incidence of hypotension was 20.00%(6/30) in the control group and 6.67%(2/30) in the study group, though no significant difference between them (Chi-square=1.298, P=0.255). The cases taking vasoactive drugs such as NE, dopamine and ephedrine were 4,4 and 10 cases respectively in the control group, and 0,2 and 2 cases in the study group. There were significant differences in the proportion of taking vasoactive drugs between them (Chi-square=6.667, P=0.010). The study group had significantly shorter time of tracheal extubation [(15.41±3.20) and (24.02±4.93)min, t=8.024, P<0.001] and time of anesthesia recovery [(10.67±3.38) and (15.24±4.26)min, t=4.603, P<0.001], longer duration of analgesic effect [(11.73±1.59) and (7.91±1.28)h, t=10.250, P<0.001], decreased SAS score [(3.82±0.41) and (5.06±0.50), t=10.504, P<0.001) and VAS score [(2.25±0.21) and (4.30±0.36), t=26.941, P<0.001], and lower incidence of adverse reactions [10.00%(3/30) and 33.33%(10/30), Chi-square=4.812, P=0.028]during the recovery period when compared with the control group. Conclusion Ropivacaine-assisted dezocine anesthesia for supratentorial tumor resection can promote recovery after anesthesia, stabilize hemodynamics and reduce stress responses during recovery period, improve sedative and analgesic effects, and reduce adverse reactions.