Effect Of Anesthesia On Renal Ischemia-reperfusion Injury In Laparoscopic Partial Nephrectomy

ObjectiveTo investigate the effect of different anesthesia on renal ischemia-reperfusion injury in patients undergoing laparoscopic partial nephrectomy,to record perioperative hemodynamic adverse events,postoperative recovery,analgesia and other indicators,changes in renal function and lipid oxidation at various time points,evaluate the effect of dexmedetomidine combined with ropivacaine in parathoracic nerve block(TPVB)combined with general anesthesia.To investigate whether dexmedetomidine as a local anesthetic adjuvant is a feasible and optimized anesthesia strategy for laparoscopic partial nephrectomyMethods1 Select 100 patients who underwent elective laparoscopic partial nephrectomy in the Department of Anesthesiology and Perioperative Medicine of the People's Hospital of Henan University,aged 18 to 64 years,BMI 18 to 25 kg/m2,ASA grade ? to ?,and gender is not limited.No nephrotoxic drugswas taken before surgery,no local anesthetic allergy,no renal hypertension,no history of chronic pain,no recent history of sedatives and analgesics,no immune system diseases or blood system diseases,no serious cardiovascular disease systemic diseases,no abnormalities in liver,kidney and coagulation function2 Grouping:The patients were divided into 5 groups by random number table method:general anesthesia group(group G),ropivacaine TPVB combined general anesthesia group(group R),dexmedetomidine intravenous infusion combined with general anesthesia group(Div group),dexmedetomidine intravenous infusion+ropivacaine TPVB combined general anesthesia group(Div+R group),dexmedetomidine mixed ropivacaine TPVB combined general anesthesia group(Dtp+R group)3 Observation indicators:Before operation:record general patient information;Intraoperative record the patient's operation,record the perioperative consumption of propofol,sufentanil and remifentanil,intraoperative hypertension,hypotension,tachycardia,bradycardia.Postoperative:Record the occurrence of adverse events in the recovery room(PACU)after anesthesia,postoperative recovery time,extubation time,postoperative recovery analgesia incidence,etc.Immediate extubation using sedation score(Ramsay score)and visual simulation score(VAS score)to assess sedation and analgesia.Laboratory indicators:Before the anesthesia,30 minutes after pneumoperitoneum,30 minutes of open renal artery,6 hours after surgery,12 hours after surgery,and 24 hours after surgery,elbow vein blood samples and indwelling urine were taken for laboratory check and determine plasma cysteine protease inhibitor C(Cys C),serum malondialdehyde(MDA)concentration,C-reactive protein(CRP)and creatinine concentration4 Anesthesia induction and maintenance:Intravenous injection of propofol 2mg/kg,sufentanil 0.5?g/kg,cis atracurium 0.2 mg/kg,laryngeal mask ventilation after mask ventilation,mechanical ventilation with anesthesia machine,Set tidal volume 8ml/kg,ventilation frequency 12 times/min,I:E1:2,PEEP 6 cmH2O,inhaled oxygen concentration 50%,inhaled oxygen flow rate 2 L/min,adjust ventilation parameters.For anesthesia maintenance,intravenous infusion of propofol 2?5 mg·kg-1·h-1,remifentanil 3?12 ?g·kg-1·h-1,and intermittent intravenous injection of cis atracurium 0.05 mg/kg.After the operation,prepatamamo 2g and tropisetron 5mg were pre-charged immediately Postoperative patient-controlled intravenous analgesia(PCIA)was used.The PCIA drug was formulated as sufentanil 2?g/kg mixed with tropisetron 10mg.The 24-hour PCIA sufentanil consumption is included in its total perioperative consumption5 Nerve block:Choose two-point block according to the surgical incision,locate bone markers such as C7,T7,spinous process,and transverse process on the body surface,and locate the target transverse process and pleura of T8,T9,T10,T11 under ultrasound.Inject 10ml of 0.5%ropivacaine at each puncture point6 Intervention measures:? Group G was simply under general anesthesia,without TPVB,and without dexmedetomidine.?Using ultrasound-guided TPVB in group R,0.5%ropivacaine was given in the paravertebral space,and dexmedetomidine was not given intravenously.?Div group received intravenous infusion of dexmedetomidine 0.5?g/kg,infusion time was lOmin,and then maintained at 0.5?g·kg-1·h-1 until the renal artery was clamped immediately.? Intravenous infusion of dexmedetomidine in the Div+R group was the same as the Div group,and TPVB was the same as the R group.? In the Dtp+R group,ultrasound was performed on TPVB,and the paravertebral space was given with dexmedetomidine 0.5?g/kg mixed ropivacaineResults1 There was no statistically significant difference in the general condition,operation time,warm ischemia time and intraoperative blood loss among the 5 groups2 Comparison of perioperative medication consumption among the 5 groups:the dosage of propofol and sufentanil in the Div+R group and Dtp+R group were lower than those in the other 3 groups,and the dosage of remifentanil in the G and Div groups was lower than that in the other 3 groups Increase(P<0.05)3 Comparison of perioperative hemodynamic adverse events in 5 groups:compared with group G,the incidence of hypertension in Div group and Dtp+R group was reduced(P<0.05);compared with group R,Div group and Div+R group The incidence of bradycardia increased(P<0.05)4 Comparison of various indexes of postoperative recovery in 5 groups of patients:the recovery time and extubation time were significantly shortened in the Dtp+R group,and the VAS score was reduced,which was statistically significant compared with the control group in the 4 groups(P<0.05);in terms of Ramsay score There was no statistically significant difference between the 5 groups(P>0.05)5 Comparison of the laboratory indexes of the 5 groups of patients:Compared with the G group and the R group,the MDA and CRP of the Div group,the Div+R group and the Dtp+R group at each time point of T2?5 were reduced(P<0.05);Comparing R group and Div group,the concentration of Cys C in Dtp+R group decreased significantly during T2?4,the difference was statistically significant(P<0.05);Compared with G group,R group and Div group 3 at T4?5,the difference was statistically significant(P<0.05)ConclusionDexmedetomidine as a ropivacaine adjuvant in thoracic paravertebral nerve block,the effect of reducing renal ischemia-reperfusion injury in patients undergoing laparoscopic partial nephrectomy is better,and the patients' short-term renal function has improved.In the perioperative management,the amount of general anesthesia drugs was reduced,the postoperative recovery time was shortened,the analgesic effect was good,and the perioperative period was more stable.