七氟醚吸入麻醉对罗哌卡因腹横肌平面阻滞子宫肌瘤患者麻醉效果的影响

Effect of inhalation anesthesia with sevoflurane on the anesthetic effect of transverse abdominis plane block with ropivacaine in patients with uterine fibroids

摘要:

目的 探讨七氟醚吸入麻醉对罗哌卡因腹横肌平面阻滞子宫肌瘤患者麻醉效果的影响。方法 选取2020年6月—2022年6月无锡市新瑞医院收治的86例腹腔镜子宫肌瘤切除术患者，依照随机数字表法分为研究组和对照组，每组43例。对照组采用全身麻醉联合罗哌卡因腹横肌平面阻滞，研究组在对照组基础上复合静吸七氟醚。比较两组患者麻醉唤醒时间、自主呼吸恢复时间、拔管时间、瑞芬太尼用量及并发症发生情况。比较麻醉诱导前（T₀），切皮前（T₁），切皮后10 min（T₂），术毕（T₃）时的心率、平均动脉压；术后2、6、12和24 h的视觉模拟评分（VAS）。术前、术毕、术后24 h采用酶联免疫吸附试验检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平。结果 研究组唤醒时间、自主呼吸恢复时间、拔管时间均短于对照组（P <0.05）。研究组与对照组T₀、T₁、T₂、T₃的心率、平均动脉压比较，结果 ①不同时间点间心率、平均动脉压比较，差异均有统计学意义（P <0.05）；②研究组与对照组心率、平均动脉压比较，差异均有统计学意义（P <0.05）；研究组T₁时心率、平均动脉压较高，T₂、T₃时心率、平均动脉压较低；③研究组与对照组心率、平均动脉压变化趋势比较，差异均有统计学意义（P <0.05）。研究组与对照组术后2、6、12和24 h的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②研究组与对照组VAS评分比较，差异有统计学意义（P <0.05）；研究组术后6、12和24 h的VAS评分较低；③研究组与对照组的VAS评分变化趋势比较，差异有统计学意义（P <0.05）。研究组与对照组术前、术毕、术后24 h的TNF-α、IL-6比较，结果 ①不同时间点TNF-α、IL-6比较，差异均有统计学意义（P <0.05）；②研究组与对照组TNF-α、IL-6比较，差异均有统计学意义（P <0.05）；研究组术毕、术后24 h的TNF-α、IL-6较低；③研究组与对照组的TNF-α、IL-6变化趋势比较，差异均有统计学意义（P <0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。研究组瑞芬太尼用量较对照组少（P <0.05）。结论 七氟醚吸入麻醉用于腹横肌平面阻滞子宫肌瘤患者，可以缩短清醒时间，稳定血流动力学，减轻术后疼痛，减少麻醉药用量，减少炎症因子释放。

Abstract:

Objective To investigate the effect of inhalation anesthesia with sevoflurane on the anesthesia effect of transverse abdominis plane block with ropivacaine in patients with uterine fibroids.Methods A total of 86 patients undergoing laparoscopic myomectomy in our hospital from June 2020 to June 2022 were selected and divided into study group (n = 43) and control group (n = 43) according to the random number table method. The control group received general anesthesia combined with transverse abdominis plane block with ropivacaine, and the study group was additionally given sevoflurane. Time to recovery from anesthesia, time to recovery of spontaneous breathing, time to extubation, dosage of remifentanil and the incidence of complications were compared between the two groups. The heart rate and mean arterial pressure before anesthesia induction (T₀), before surgical incision making (T₁), 10 min after surgical incision making (T₂), and at the end of the surgery (T₃) and the Visual Analogue Scale (VAS) score 2 h, 6 h, 12 h and 24 h after the surgery were compared. Besides, serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) before the surgery, at the end of the surgery and 24 h after the surgery were measured via enzyme-linked immunosorbent assay.Results The time to recovery from anesthesia, recovery of spontaneous breathing and time to extubation in the study group were shorter than those in the control group (P < 0.05). The heart rate and the mean arterial pressure at T₀, T₁, T₂ and T₃ in the study group and the control group were compared, and the results exhibited that they were different among the time points (P < 0.05) and between the groups (P < 0.05). The heart rate and mean arterial pressure were higher at T₁ and lower at T₂ and T₃. Besides, the change trends of the heart rate and the mean arterial pressure were different between the study group and the control group (P < 0.05). The VAS scores 2 h, 6 h, 12 h and 24 h after the surgery in the two groups were compared, and the results demonstrated that the VAS scores were different at distinct time points (P < 0.05) and between the study group and the control group (P < 0.05). The VAS scores 6 h, 12 h and 24 h after the surgery were lower in the study group, and there were differences in the change trends of VAS scores between the study group and the control group (P < 0.05). The levels of TNF-α and IL-6 before the surgery, at the end of the surgery and 24 h after the surgery were also compared, which suggested that they were different among the time points (P < 0.05) and between the study group and the control group (P < 0.05). Specifically, the levels of TNF-α and IL-6 after the surgery and 24 h after the surgery were lower in the study group. The change trends of the levels of TNF-α and IL-6 were different between the two groups as well (P < 0.05). There was no difference in the overall incidence of complications between the two groups (P > 0.05). The dosage of remifentanil was lower in the study group than in the control group (P < 0.05).Conclusions Inhalation anesthesia with sevoflurane shortens the time to recovery from anesthesia, stabilizes the hemodynamics, relieves postoperative pain, reduces the dosage of anesthetics, and decreases the release of inflammatory factors in patients with uterine fibroids undergoing transverse abdominis plane block with ropivacaine.