右美托咪定复合超声引导下TAP阻滞麻醉对腹腔镜下腹股沟疝修补术病人Aβ-42、Tau蛋白的影响

范之丹; 渠兴乾; 王卫军

doi:10.13898/j.cnki.issn.1000-2200.2023.03.015

右美托咪定复合超声引导下TAP阻滞麻醉对腹腔镜下腹股沟疝修补术病人Aβ-42、Tau蛋白的影响

Effect of dexmedetomidine combined with ultrasound-guided TAP block anesthesia on amyloid β-protein and Tau protein in patients undergoing laparoscopic inguinal hernia repair

摘要

摘要:
目的探讨右美托咪定复合超声引导下腹横肌平面(TAP)阻滞麻醉对腹腔镜下腹股沟疝修补术病人血清β-42淀粉样蛋白(Aβ-42)和Tau蛋白的影响。
方法选取行腹腔镜下腹股沟疝修补术病人100例，随机分为对照组和观察组，各50例。对照组行喉罩全麻，观察组采用超声引导下TAP阻滞联合右美托咪定麻醉。记录2组病人切皮时(T1)、手术开始1 h(T2)、手术结束即刻(T3)的平均动脉压和心率(HR)、血氧饱和度。比较2组疼痛视觉模拟评分(VAS)、简易智能状态检查量表(MMSE)评分、术后认知功能障碍(POCD)的发生率及Aβ-42和Tau蛋白表达水平。
结果2组病人术后即刻和术后6、24、48 h VAS评分逐渐降低降低(P < 0.05)；观察组术后6、24、48 h VAS评分均明显低于对照组(P < 0.01)。观察组T2、T3 HR均明显低于对照组(P < 0.01)，且T2、T3时HR低于T1(P < 0.05)。术后观察组POCD的发生率为6.00%(3/50)，低于对照组的22.00%(11/50)(P < 0.05)。术后1、7 d 2组MMSE评分均低于麻醉前(P < 0.05)，且观察组MMSE评分明显高于对照组(P < 0.01)。术后7 d 2组Tau蛋白水平均高于麻醉前(P < 0.05)，Aβ-42蛋白水平均低于麻醉前(P < 0.05)，Tau/Aβ-42值高于麻醉前(P < 0.05)；且观察组Tau蛋白水平及Tau/Aβ-42值均低于对照组(P < 0.05和P < 0.01)，Aβ-42水平明显高于对照组(P < 0.01)。
结论超声引导下TAP阻滞麻醉联合右美托咪定在腹腔镜下腹股沟疝修补术中镇痛效果显著，同时有效改善病人的认知功能，调节术后血清Aβ-42和Tau蛋白水平，降低POCD发生率。

Abstract:
ObjectiveTo investigate the effect of dexmedetomidine combined with ultrasound-guided transversus abdominis plane(TAP) block anesthesia on the serum level of β-42 amyloid(Aβ-42) and Tau protein in patients undergoing laparoscopic inguinal hernia repair.
MethodsA total of 100 patients undergoing laparoscopic inguinal hernia repair were selected and randomly divided into control group and observation group(50 cases in each group).The control group received laryngeal mask general anesthesia, and the observation group received ultrasound-guided TAP block combined with dexmedetomidine anesthesia.The mean arterial pressure, heart rate(HR) and blood oxygen saturation at the time of skin incision(T1), 1 h at the beginning of operation(T2) and immediate time after operation(T3) were recorded.The pain visual analogue scale(VAS) score, mini-mental state examination(MMSE) score, incidence of postoperative cognitive dysfunction(POCD) and expression levels of Aβ-42 and Tau protein were compared between the two groups.
ResultsThe VAS scores in the two groups decreased gradually at immediate time after operation, 6 h, 24 h and 48 h after operation(P < 0.05), and the VAS scores at 6 h, 24 h and 48 h after operation in observation group were significantly lower than those in control group(P < 0.01).The HR in observation group at T2 and T3 was significantly lower than that in control group(P < 0.01), and HR at T2 and T3 was lower than that at T1(P < 0.05).The incidence of POCD in observation group was 6.00%(3/50), which was lower than 22.00%(11/50) in control group(P < 0.05).The MMSE scores in the two groups at 1 d, 7 d after operation were lower than those before anesthesia(P < 0.05), and which in observation group were significantly higher than those in control group(P < 0.01). The Tau protein level and Tau/Aβ-42 value in the two groups at 7 d after operation were higher than those before anesthesia(P < 0.05), the Aβ-42 protein level was lower than that before anesthesia(P < 0.05), and the Tau protein level and Tau/Aβ-42 value in observation group were lower than that in control group(P < 0.05 and P < 0.01), the Aβ-42 protein level was significantly higher than that in control group(P < 0.01).
ConclusionsUltrasound-guided TAP block anesthesia combined with dexmedetomidine has good analgesic effects in laparoscopic inguinal hernia repair, which can effectively improve the patient's cognitive function, regulate the postoperative serum level of Aβ-42 and Tau protein, and decrease the incidence of POCD.

HTML全文

参考文献(23)

施引文献

资源附件(0)