罗哌卡因局部浸润麻醉联合全身麻醉对行腹腔镜完全腹膜外疝修补术患者的影响

目的探讨罗哌卡因局部浸润麻醉联合全身麻醉对行腹腔镜完全腹膜外疝修补术（TEP）患者的应激反应及临床指标影响。 方法本研究选取于2017年12月至2019年1月天长市中医院麻收治并接受TEP术的患者共98例，按照数字随机表达法对所有患者的入院序号进行随机分配分组，每组49例。对照组实施全身麻醉，观察组实施罗哌卡因局部浸润麻醉联合全身麻醉。麻醉前（T1）、手术开始即刻（T2）、术毕30 min（T3）、术毕1 h（T4）及术毕6 h（T5）共5个时间对比2组的应激反应及术后疼痛情况。 结果T1及T2阶段NE、E、MAP及HR指标，2组比较，差异均无统计学意义（P>0.05）；T3至T5阶段，观察组的NE、E、MAP及HR均低于对照组，差异有统计学意义（P<0.05）。术前2组细胞因子IL-6，CRP及WBC指标比较，差异均无统计学意义（P>0.05）；观察组在术后的细胞因子IL-6，CRP及WBC指标均较对照组低，差异有统计学意义（P<0.05）。观察组在术后6~72 h的NRS评分均低于对照组，差异有统计学意义（P<0.05）。 结论TEP术中选择罗哌卡因局部浸润麻醉联合全身麻醉可有效抑制患者围术期间的应激反应，降低炎性细胞因子指标，缓解术后疼痛情况，值得临床推广。

Effects of ropivacaine local infiltration anesthesia combined with general anesthesia on patients undergoing laparoscopic total extraperitoneal hernia repair

ObjectiveTo investigate the effects of ropivacaine local infiltration anesthesia combined with general anesthesia on stress reaction and clinical indicator of patients undergoing laparoscopic total extraperitoneal hernia repair (TEP). Methods98 cases who were admitted to Tianchang Hospital of Traditional Chinese Medicine from December 2017 to January 2019 and undergoing laparoscopic TEP surgery were selected as the study subjects. According to the numerical random expression method, the admission serial number of all patients were randomly assigned to 2 groups, with 49 cases in each group. The control group received general anesthesia, and the observation group received ropivacaine local infiltration anesthesia combined with general anesthesia. Before anesthesia (T1), immediately after operation (T2), 30 minutes after operation (T3), 1 hour after operation (T4) and 6 hours after operation (T5), stress response and postoperative pain were compared between the two groups. ResultsThere was no significant difference in NE, E, MAP and HR between the two groups during T1 and T2 (P>0.05). From T3 to T5, NE, E, MAP and HR in the observation group were significantly lower than those in the control group (P<0.05). There were no significant differences in cytokine IL-6, CRP and WBC between the two groups before operation (P>0.05). The postoperative level of cytokine indicators IL-6, CRP and WBC of the observation group were significantly lower than those of the control group (P<0.05). The NRS score of the observation group was significantly lower than that of the control group at 6 h to 72 h after surgery (P<0.05). ConclusionThe application of ropivacaine local infiltration anesthesia combined with general anesthesia in laparoscopic TEP can effectively inhibit perioperative stress response of patients, reduce inflammatory cytokine indicators and relieve postoperative pain, which is worthy of clinical promotion.