右美托咪定静脉输注联合罗哌卡因局部浸润在腹腔镜妇科手术镇痛的效果  

Analgesic effects of intravenous infusion of dexmedetomidine combined with local infiltration of ropivacaine in patients undergoing gynecologic laparoscopic surgery

作　　者：夏小萍[1] 朱蓓蓓[1] 梁樱[1] 马正良[1] 韩克[2] 朱湘红[2] 汤小秋 

机构地区：[1]南京大学医学院南京鼓楼医院麻醉科,210008 [2]南京大学医学院南京鼓楼医院妇产科,210008

出　　处：《临床麻醉学杂志》2014年第10期973-976,共4页Journal of Clinical Anesthesiology

基　　金：南京市卫生人才项目;南京市卫生局课题(编号:YKK08072)

摘　　要：目的观察右美托咪定静脉输注联合罗哌卡因局部浸润对腹腔镜妇科手术镇痛效果。方法 80例腹腔镜妇科手术患者随机均分为右美托咪定组(D组):静脉右美托咪定;罗哌卡因组(R组):0.5%罗哌卡因局部浸润;右美托咪定复合罗哌卡因组(DR组):静脉右美托咪定联合0.5%罗哌卡因局部浸润;对照组(C组):不用右美托咪定和罗哌卡因。记录术毕苏醒时间、拔管时间及第一次排气时间。记录入PACU、术后6、12、24h时VAS评分,如患者VAS评分>6分,则给予哌替啶50mg,并记录24h内使用哌替啶例数。记录术后24h时BCS评分及不良反应发生情况。结果四组患者苏醒时间和拔管时间比较差异无统计学意义。与C组比较,DR组第一次排气时间明显缩短(P<0.05)。与C组比较,术后PACU、6hR组、D组、DR组和术后12、24hDR组VAS评分明显降低(P<0.05)。与R组和D组比较,DR组术后6、12、24hVAS评分明显降低(P<0.05)。24h内使用哌替啶C组8例,其他三组均未使用哌替啶(P<0.05)。与DR组比较,术后24hR组、D组和C组BCS评分4分例数明显减少(P<0.05)。而DR组无一例患者发生恶心呕吐,C组有9例、R组有3例、D组有2例。此外,C组有1例患者发生苏醒躁动。结论右美托咪定静脉输注联合罗哌卡因局部浸润用于腹腔镜妇科手术比单纯应用罗哌卡因或右美托咪定的镇痛效果好、镇痛时间长。Objective To observe analgesic effects of intravenous infusion of dexmedetomidine combined with local infiltration of ropivacaine in patients undergoing gynecologic laparoscopic surgery.Methods Eighty female patients undergoing gynecologic laparoscopic surgery were divided into four groups equally and randomly.The patients in group D were treated with dexmedetomidine intravenously（n=20）,the patients in group R were treated with local infiltration of 0.5%ropivacaine（n=20）,the patients in group DR were treated with dexmedetomidine intravenously and local infiltration of 0.5%ropivacaine（n=20）,and the patients in group C（control group）did not receive dexmedetomidine or ropivacaine（n=20）.The postoperative recovery time,endotracheal extubation time,and first anal exhaust time of the patients were recorded.The postoperative VAS was recorded at the time point of admission to PACU and 6,12,and 24 hafter operation.If the VAS score of the patients was over 6,50 mg pethidine was used and the number of patients who used pethidine was recorded.The postoperative incidence of adverse effects were recorded and patients’comfort was evaluated by Bruggrmann comfort scale（BCS）after the first postoperative 24 h.Results There was no significant difference in the recovery time and extubation time among the four groups.The first anal exhaust time of was shorter in the group DR than in the group C（P〈0.05）.Compared with the group C,the VAS score in the group DR was significantly lower at admission to PACU and 6,12,and 24 hafter operation（P〈0.05）,and the VAS score in the groups R and D was lower at admission to PACU and6 hafter operation（P〈0.05）.There were 8patients in group C,but none in the other three groups,who used pethidine.Compared with the DR group,BCS score of four cases decreased significantly at24 hafter operation in the groups R,D,and C（P〈0.05）.Nine patients in the group C,3in the group R,2in the group D,but none in the DR group presented nausea and vomiting.In addition,1patient

关 键 词：右美托咪定 罗哌卡因 腹腔镜 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]