罗哌卡因腹横肌平面阻滞与酒石酸布托啡诺复合用药对腹腔镜子宫全切术患者镇痛及应激反应的影响

Effect of transversus abdominis plane block using ropivacaine combined with butorphanol tartrate on analgesia and stress response in patients undergoing laparoscopic total hysterectomy

摘要:

目的 探讨罗哌卡因腹横肌平面阻滞联合酒石酸布托啡诺对腹腔镜子宫全切术患者镇痛效果及其对应激反应的影响。方法 选取2022年12月—2023年12月北安市第一人民医院接收的腹腔镜子宫全切术患者102例，通过随机数字表法分为对照组（51例，接受罗哌卡因腹横肌平面阻滞麻醉）和联合组（51例，在对照组基础上复合酒石酸布托啡诺用药）。比较两组围手术期指标、数字疼痛评分（NRS）、Ramsay评分、匹兹堡睡眠质量指数（PSQI）、应激指标、40项恢复质量（QoR-40）评分及不良反应发生率。结果 联合组肠鸣音恢复时间、首次下床时间和住院时间均短于对照组（P 0.05）。联合组术后2 h NRS及术后第1夜PSQI评分均低于对照组（P 0.05），术后2 h Ramsay评分高于对照组（P 0.05）。联合组术后12 h NRS及术后第2夜PSQI评分均低于对照组（P 0.05），术后12 h Ramsay评分高于对照组（P 0.05）。联合组术后12 h与术后2 h的NRS、Ramsay及术后第2夜较第1夜PSQI评分的差值均大于对照组（P 0.05）。联合组术后24 h 皮质醇（Cor）、促肾上腺皮质激素（ACTH）、血管紧张素Ⅱ（AngⅡ）均低于对照组（P 0.05）。联合组术前及术后24 h Cor、ACTH、AngⅡ的差值均小于对照组（P 0.05）。联合组术后24 h、术后48 h的QoR-40评分均高于对照组（P 0.05）。联合组与对照组不良反应总发生率比较，差异均无统计学意义（P 0.05）。结论 罗哌卡因腹横肌平面阻滞联合酒石酸布托啡诺复合用药能有效减轻腹腔镜子宫全切术后患者的疼痛，降低应激反应，促进术后恢复，具有较高的安全性，值得在临床中广泛应用。

Abstract:

Objective To investigate the effect of transversus abdominis plane (TAP) block using ropivacaine combined with butorphanol tartrate on analgesia and stress response in patients undergoing laparoscopic total hysterectomy.Methods A total of 102 patients undergoing laparoscopic total hysterectomy at Bei'an First People's Hospital from December 2022 to December 2023 were selected and randomly divided into a control group (n = 51, receiving TAP block using ropivacaine) and a combination group (n = 51, receiving TAP block using ropivacaine combined with butorphanol tartrate). Perioperative indicators, Numeric Rating Scale (NRS) scores, Ramsay scores, Pittsburgh Sleep Quality Index (PSQI) scores, stress markers, Quality of Recovery-40 (QoR-40) scores, and incidence of adverse reactions were compared between the two groups.Results The combination group demonstrated shorter times to bowel sound recovery, first ambulation, and hospital discharge compared with the control group (P 0.05). The NRS scores at 2 h postoperatively and the PSQI scores on the first postoperative night were significantly lower in the combination group than in the control group (P 0.05), whereas the Ramsay scores at 2 h postoperatively were significantly higher in the combination group (P 0.05). The NRS scores at 12 h postoperatively and the PSQI scores on the second postoperative night remained significantly lower in the combination group than in the control group (P 0.05), while the Ramsay scores were significantly higher in the combination group (P 0.05). Furthermore, the changes in NRS and Ramsay scores from 2 h to 12 h postoperatively, as well as the change in PSQI scores from the first to the second postoperative night, were all significantly greater in the combination group than in the control group (P 0.05). At 24 h postoperatively, serum levels of cortisol (Cor), adrenocorticotropic hormone (ACTH), and angiotensin II (Ang II) were significantly lower in the combination group than in the control group (P 0.05). In addition, the changes in Cor, ACTH, and Ang II levels from preoperative baseline to 24 h postoperatively were significantly smaller in the combination group (P 0.05). The QoR-40 scores at 24 h and 48 h postoperatively were significantly higher in the combination group than in the control group (P 0.05). There was no statistically significant difference in the overall incidence of adverse events between the two groups (P 0.05).Conclusion TAP block using ropivacaine combined with butorphanol tartrate effectively reduces pain and stress response in patients undergoing laparoscopic total hysterectomy, promotes postoperative recovery with high a safety profile, and is worth widespread clinical application.