摘要
目的比较罗哌卡因与布比卡因腰硬联合麻醉对老年前列腺电切术患者应激反应和认知功能的影响。方法前瞻性选取2023年6月至2025年6月在成都市武侯区人民医院进行前列腺电切术的150例老年良性前列腺增生患者为研究对象,采用随机数表法将患者分为罗哌卡因组(罗哌卡因腰硬联合麻醉,76例)和布比卡因组(布比卡因腰硬联合麻醉,74例)。所有患者术中均接受标准体温保护措施。比较两组感觉与运动阻滞起效及维持时间、不良反应发生率,以及不同时间点应激反应(肾上腺素、皮质醇)、认知功能[简易智力状态量表(MMSE)]和血流动力学[心率(HR)、平均动脉压(MAP)]指标。结果罗哌卡因组感觉及运动阻滞维持时间均短于布比卡因组,运动阻滞起效时间长于布比卡因组(P<0.05)。两组MMSE评分的组间主效应、时间主效应及交互效应均有统计学意义(P<0.05);两组术后24 h、7 d时MMSE评分均较术前下降(P<0.05),且罗哌卡因组均高于布比卡因组(P<0.05)。与术前比较,两组术后24 h血清肾上腺素、皮质醇水平均显著升高,且罗哌卡因组低于布比卡因组(P<0.05)。两组HR、MAP的组间主效应、时间主效应及交互效应均有统计学意义(P<0.05);两组麻醉5 min(T_(1))、麻醉10 min(T_(2))时的HR、MAP均较麻醉前(T_(0))下降(P<0.05),且罗哌卡因组T_(1)、T_(2)时的HR、MAP均高于布比卡因组(P<0.05)。罗哌卡因组术后不良反应发生率为10.53%,与布比卡因组(17.57%)比较,差异无统计学意义(P>0.05)。结论与布比卡因相比,罗哌卡因用于老年前列腺电切术患者的腰硬联合麻醉,能更有效减轻术中应激反应,更稳定地维持血流动力学,缩短感觉与运动阻滞时间,并有助于降低术后早期认知功能损伤的发生风险,且安全性较高。
Objective To compare the effects of ropivacaine and bupivacaine combined spinal-epidural anesthesia on the stress response and cognitive function of elderly patients undergoing transurethral resection of the prostate.Methods A total of 150 elderly patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate at Chengdu Wuhou District People's Hospital from June 2023 to June 2025 were prospectively enrolled.Using the random number table method,patients were divided into the ropivacaine group(combined spinal-epidural anesthesia with ropivacaine,n=76)and the bupivacaine group(combined spinal-epidural anesthesia with bupivacaine,n=74).All patients received standard temperature protection measures during surgery.The onset and maintenance times of sensory and motor block,the incidence of adverse reactions,as well as stress response indicators[adrenaline(EPI),cortisol(COR)],cognitive function[Mini-Mental State Examination(MMSE)]and hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP)]at different time points were compared between the two groups.Results The maintenance times of both sensory and motor block in the ropivacaine group were significantly shorter than those in the bupivacaine group,while the onset time of motor block in the ropivacaine group was significantly longer than that in the bupivacaine group(P<0.05).The intergroup main effect,time main effect,and interaction effect on MMSE scores were statistically significant in both groups(P<0.05).The MMSE scores at 24 hours and 7 days after surgery were significantly lower than those before surgery in both groups(P<0.05),and the scores in the ropivacaine group were significantly higher than those in the bupivacaine group at both time points(P<0.05).Compared with preoperative levels,serum EPI and COR levels at 24 hours after surgery were significantly increased in both groups,and the levels in the ropivacaine group were significantly lower than those in the bupivacaine group(P<0.05).The intergroup main effect,time main effect,and interaction effect on HR and MAP were statistically significant in both groups(P<0.05).HR and MAP at 5 minutes(T_(1))and 10 minutes(T_(2))after anesthesia induction were significantly lower than those before anesthesia(T_(0))in both groups(P<0.05),and HR and MAP at T_(1)and T_(2)in the ropivacaine group were significantly higher than those in the bupivacaine group(P<0.05).The incidence of postoperative adverse reactions in the ropivacaine group was 10.53%,which showed no statistically significant difference compared with 17.57%in the bupivacaine group(P>0.05).Conclusion Compared with bupivacaine,ropivacaine used for combined spinal-epidural anesthesia in elderly patients undergoing transurethral resection of the prostate can more effectively alleviate the intraoperative stress response,maintain hemodynamic stability more steadily,shorten the maintenance time of sensory and motor block,and help reduce the risk of early postoperative cognitive impairment,with a comparable safety profile.
作者
卓朋
罗帆
陈亮
曾祥浩
陈杰
ZHUO Peng;LUO Fan;CHEN Liang;ZENG Xianghao;CHEN Jie(Department of Anesthesiology,Wuhou District People's Hospital/Maternal and Child Health Hospital,Chengdu 610041,China;Department of Anesthesiology,General Hospital of Western Theater Command of the PLA,Chengdu 610083,China;Department of Anesthesiology,Chengdu Aircraft Industry Hospital,Chengdu 610092,China;Department of Breast Cancer,Sichuan Provincial People's Hospital,Chengdu 610072,China)
出处
《转化医学杂志》
2026年第3期485-490,共6页
Translational Medicine Journal
基金
四川省科技计划项目(2023YFS0132)。
关键词
罗哌卡因
布比卡因
前列腺电切术
老年人
应激反应
认知功能
ropivacaine
bupivacaine
transurethral resection of the prostate
aged
stress response
cognitive function
