右美托咪定混合罗哌卡因超声引导下髂腹股沟神经及髂腹下神经阻滞在老年腹股沟疝修补术的应用  

Clinical application of dexmedetomidine as an adjunct to ropivacaine in ultrasound-guided ilioinguinal/iliohypogastric nerve block for geratic inguinal hernia repair

作　　者：覃兆军[1] 占乐云[1] 向春艳[2] 周密[1] 刘婷婷[1] 陶虓嫣 邓鹏飞 

机构地区：[1]三峡大学人民医院麻醉科,宜昌443000 [2]三峡大学人民医院药学部,宜昌443000

出　　处：《中华疝和腹壁外科杂志（电子版）》2017年第6期460-464,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的观察右美托咪定混合罗哌卡因行超声引导下髂腹股沟神经及髂腹下神经阻滞在老年腹股沟疝修补术中的有效性及安全性。方法选取2016年1-10月,三峡大学人民医院老年腹股沟疝修补术患者60例,随机分为A组和B组,每组患者30例。A组采用0.6μg/kg右美托咪定混合0.4%罗哌卡因20 ml进行超声引导下髂腹股沟神经及髂腹下神经阻滞;B组采用传统方法单用0.4%罗哌卡因20 ml进行神经阻滞。观察2组麻醉前(T0)、手术开始后15 min(T1)、30 min(T2)及结束时(T3)平均动脉压、心率、脉搏血氧饱和度及Ramsay评分;术中麻醉效果优秀率、患者整体满意率、恶心呕吐、体动、心动过缓及呼吸抑制发生率、镇痛药辅助率、利多卡因使用量、术后12、24 h静态及动态疼痛视觉模拟评分。结果与B组相比,A组T1~3时平均动脉压、心率均降低、Ramsay评分均增加(P<0.05);术中麻醉效果优秀率及患者整体满意率均升高(P<0.05);术中体动发生率、镇痛药辅助率及利多卡因使用量均降低(P<0.05);术后12 h时静态及动态疼痛视觉模拟评分均降低(P<0.05)。2组术中恶心呕吐、心动过缓及呼吸抑制发生率差异无统计学意义(P>0.05)。结论右美托咪定混合罗哌卡因超声引导下髂腹股沟神经及髂腹下神经阻滞,可为老年腹股沟疝修补术患者提供满意的麻醉效果和术后短期镇痛作用。Objective To observe the efficacy and safety of dexmedetomidine as an adjunct to ropivacaine in ultrasound-guided ilioinguinal/iliohypogastric nerve block for geratie inguinal hernia repair. Methods From January 2016 to October 2016, sixty eider patients who underwent selective inguinal hernia repair were randomly divided into group A and group B with 30 patients in each group. Patients in group A received ultrasound-guided ilioinguinal/iliohypogastric nerve block with 0.4% ropivaeaine 20 ml combined with 0.6 μg/kg dexmedetomidine as an adjunct, while patients in group B received only 0.4% ropivacaine 20 ml for nerve block according to the traditional method. The mean artery pressure, heart rate, pulse, oxygen saturation, and Ramsay scores before anesthesia （T0 ） , 15 minutes after surgery （ T1 ） , 30 minutes after surgery （T2 ） and at the end of surgery （ T3 ） were recorded. The excellence rate of anesthetic effect, the operation satisfaction rate of patients, the incidence of nausea and vomiting, accidental body moving, bradycardia, respiratory depression, usage rate of analgesic, and dosage of lidocaine during the operation were also recorded. The visual analogue scale scores at rest and during movement were recorded at 12 hours and 24 hours after surgery. Results Compared with group B, the mean artery pressure and heart rate were decreased, and Ramsay scores were increased at T1-3 in group A （ P 〈 0.05 ）. The excellence rate of anesthetic effect and operation satisfaction rate of patients in group A were significantly higher than in group B （P 〈 0.05 ）. While the rate of accidental body moving, usage rate of analgesic and dosage of lidocaine during the operation in group A were significantly lower than in group B （P 〈 0.05 ）. The visual analogue scale scores at rest and during movement at 12 hours after operation in group A were lower compared with group B （P 〈 0.05）. There were no differences in the incidences of nausea and vomiting, bradycardia and respiratory depres

关 键 词：疝 腹股沟 右美托咪定 超声引导 髂腹股沟神经/髂腹下神经阻滞 老年人 

分 类 号：R614[医药卫生—麻醉学]