右美托咪定复合罗哌卡因腹横肌平面阻滞对亲属活体肾移植供肾患者术后恢复的影响  

Effect of ultrasound guided subcostal transverses abdominis plane block with dexmedetomidine mixed ropivacaine in related living kidney transplantation donor

作　　者：翟明玉[1] 李娟[1] 谷海[1] 音樱[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2016年第5期441-444,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定复合罗哌卡因腹横肌平面（TAP）阻滞对亲属活体肾移植供肾患者术后的镇痛效果及早期恢复的影响。方法选择择期行亲属活体肾移植供肾患者40例,男15例,女25例,年龄20~60岁,ASAⅠ或Ⅱ级,随机分为右美托咪定＋罗哌卡因组（D组）和单纯罗哌卡因组（C组）,每组20例。所有患者术毕在超声引导下行手术侧TAP阻滞。D组给予右美托咪定1μg/kg＋0.375%罗哌卡因20ml,C组给予0.375%罗哌卡因20 ml。记录术后2、4、8、24、48h静息、活动时VAS评分和Ramsay评分,记录手术时间、感觉阻滞维持时间、术后首次镇痛泵按压时间、术后24h内有效按压次数、需使用氟比洛芬酯或咪达唑仑例数、患者术后第1天和第2天的尿量、首次排气时间。测定患者术前、术后第2天和术后第5天血清中尿素氮（BUN）和肌酐（Cr）的浓度。结果术后4、8h静息和活动时D组VAS评分明显低于C组（P〈0.05）;两组Ramsay评分差异无统计学意义。D组术后感觉阻滞维持时间明显长于C组、首次按压镇痛泵时间明显长于C组、术后24h内有效按压次数明显少于C组（P〈0.05）;D组使用氟比洛芬酯、咪达唑仑例数少于C组。术后第1天D组尿量明显多于C组、首次排气时间明显短于C组（P〈0.05）。术后第2天D组BUN、Cr浓度明显低于C组（P〈0.05）。结论右美托咪定复合罗哌卡因TAP阻滞能增强罗哌卡因的阻滞效果,延长阻滞时间,促进术后恢复。Objective To investigate the effect of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine mixed ropivacaine in related-living kidney transplantation donor.Methods Forty related living kidney transplantation donors（male 15 cases,female 25 cases,aged 20-60 years,ASA gradeⅠ orⅡ）were randomized into dexmedetomidine group（group D,n=20）and control group（group C,n=20）.All the patients received ultrasound-guided subcostal TAP block after operation,group D with dexmedetomidine 1μg/kg and 0.375%ropivacaine to 20 ml,and group C with 0.375%ropivacaine 20 ml.All the patients were assessed with both Ramsay scores and Visual Analogue Scale（VAS）at rest or on moving at 2,4,8,24 and 48hours after operation.The duration of sensory blockade,the first time and the times of pressing the analgesia pump in the first24 hours after operation,the requirements of flurbiprofen axetil and midazolam were recorded.The urine on the first and the second day after operation and the first flatus time were compared.The plasma concentrations of urea nitrogen（BUN）and creatinine（Cr）before surgery and on the second and fifth day after operation were determined.Results Compared with group C,the scores of VAS were decreased at 4and 8hours after operation in group D（P〈0.05）.There were no differences in Ramsay scores between the two groups.Compared with group C,less frequency of use of flurbiprofen axetil（15%vs 0%）and midazolam（10% vs 0%）in group D,longer time of sensory blockade,postponed time to firstly press the analgesia pump and the less frequency of pressing the analgesia pump in group D（P〈0.05）,the urine on the first day was increased and the first flatus time was earlier,the plasma concentrations of BUN and Cr were significantly lower on the second day after operation in group D（P〈0.05）.Conclusion Dexmedetomidine mixed ropivacaine can promote the anaesthesia of ultrasound-guided subcostal TAP block with ropivacaine,prolong the time of sensory blockade and improve

关 键 词：右美托咪定 罗哌卡因 亲属活体肾移植 超声引导腹横肌平面阻滞 术后恢复 

分 类 号：R614[医药卫生—麻醉学]