不同剂量右美托咪定联合罗哌卡因TAPB对腹腔镜腹股沟疝修补术患者免疫炎症反应和认知功能的影响

摘要 目的：探讨不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞（TAPB）对腹腔镜腹股沟疝修补术患者免疫炎症反应和认知功能的影响。方法：根据随机数字表法将2020年3月至2022年3月期间合肥市第二人民医院收治的150例腹腔镜腹股沟疝修补术患者分为A组（n=75）、B组（n=75）。两组均采用右美托咪定联合罗哌卡因TAPB，A组给予0.5 μg/kg右美托咪定，B组给予1 μg/kg右美托咪定。对比两组血流动力学、视觉模拟评分（VAS）、简易智能状态检查量表（MMSE）评分、术后认知功能障碍（POCD）发生率、炎症反应、免疫功能相关指标。结果：与A组手术开始时1 h（T1）、手术结束即刻（T2）时间点相比，B组平均动脉压（MAP）、心率（HR）更低（P<0.05）。B组POCD发生率低于A组（P<0.05）。与A组术后1 d、术后2 d相比，B组 MMSE评分更高（P<0.05）。与A组术后12 h、术后24 h、术后48 h相比 ，B组VAS评分更低（P<0.05）。与A组术后2 d相比，CD8P更低，B组 CD3⁺、CD4⁺、CD4⁺/CD8⁺更高（P<0.05）。与A组术后2 d相比，B组肿瘤坏死因子-α （TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）更低（P<0.05）。结论：腹腔镜腹股沟疝修补术患者采用1 μg/kg剂量右美托咪定联合罗哌卡因TAPB麻醉，可减轻疼痛感，缓解免疫炎症反应程度，维持血流动力学稳定，同时还可降低POCD发生率。

Effects of Different Doses of Dexmedetomidine Combined with Ropivacaine TAPB on Immune Inflammatory Response and Cognitive Function in Patients Undergoing Laparoscopic Inguinal Hernia Repair

ABSTRACT Objective: To investigate the effects of different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block (TAPB) on immune inflammatory response and cognitive function in patients undergoing laparoscopic inguinal hernia repair. Methods: 150 patients with laparoscopic inguinal hernia repair who were admitted to the Second People''s Hospital of Hefei from March 2020 to March 2022 were divided into group A (n=75) and group B (n=75) according to the random number table method.Both groups were treated with dexmedetomidine combined with ropivacaine TAPB, group A was given 0.5 μg/kg dexmedetomidine and group B was given 1 μg/kg dexmedetomidine. The hemodynamics, visual analogue scale (VAS), mini-mental state examination (MMSE) score, incidence of postoperative cognitive dysfunction (POCD), inflammatory response and immune function related indicators were compared in two groups. Results: Compared with group A at the beginning of operation 1 h (T1) and immediately after the end of operaion (T2), mean arterial pressure (MAP) and heart rate (HR) were lower in group B (P<0.05). The incidence of POCD in group B was lower than that in group A (P<0.05). Compared with group A 1 d and 2 d after operation, the MMSE score in group B was higher (P<0.05). Compared with group A at 12 h, 24 h and 48 h after operation, the VAS score in group B was lower (P<0.05). Compared with group A 2 d after operation, CD8⁺ was lower, and CD3⁺, CD4⁺ and CD4⁺/CD8⁺ were higher in group B(P<0.05). Compared with group A 2 d after operation, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were lower in group B (P<0.05). Conclusion: Anesthesia with 1 μg/kg dose of dexmedetomidine combined with ropivacaine TAPB in patients undergoing laparoscopic inguinal hernia repair, which can reduce pain, alleviate the degree of immune inflammatory response, maintain hemodynamic stability, and reduce the incidence of POCD.