右美托咪定联合罗哌卡因行腹横肌平面阻滞对子宫肌瘤患者术后镇痛的影响  

Dexmedetomidine Combined with Ropivacaine for Ultrasound-guided Transverses Abdominis Plane Block Alleviates Postoperative Pain in Patients Following Laparoscopic Myomectomy

作　　者：蒋志平[1] 张蕾[2] JIANG Zhiping;ZHANG Lei(Maternity and Child Health Hospital of Suizhou City,Suizhou 441300,China)

机构地区：[1]随州市妇幼保健院,湖北随州441300 [2]武汉大学人民医院,湖北武汉430061

出　　处：《现代医院》2018年第9期1361-1364,共4页Modern Hospitals

摘　　要：目的探讨超声引导下右美托咪定联合罗哌卡因行腹横肌平面阻滞对腹腔镜下子宫肌瘤剔除患者术后镇痛效果的影响。方法择期行腹腔镜子宫肌瘤剔除术患者40例,ASAⅠ～Ⅱ级,随机分为两组:右美托咪定+罗哌卡因组(DR组)和罗哌卡因组(R组),每组20例。手术结束后两组患者在超声引导下行双侧腹横肌平面阻滞,DR组给予右美托咪定1μg/kg+0. 25%罗哌卡因40 m L,每侧20 m L; R组给予0. 25%罗哌卡因40 m L,每侧20 m L。术后均使用曲马多镇痛,比较两组术后2、6、12、24、48 h静息及活动时VAS疼痛评分、舒适状态VAS评分,首次追加镇痛药时间,术后48 h内镇痛药物用量及不良反应发生率。结果术后6 h静息疼痛评分及术后2 h、6 h和12 h活动疼痛评分DR组低于R组(P <0. 05),首次追加镇痛药物的时间DR组大于R组(P <0. 05),曲马多的用量DR组少于R组(P <0. 05),术后6 h、12 h舒适状态VAS评分DR组高于R组(P <0. 05),两组不良反应发生率无统计学差异。结论联合使用右美托咪定和罗哌卡因行腹横肌平面阻滞可以延长阻滞的时间,增强阻滞的效果,提高患者的舒适度,加快术后恢复。Objective To investigate the effects of ultrasound-guided transverses abdominis plane block with dexme- detomidine and ropivaeaine in patients following laparoseopie myomectomy. Methods Forty patients, American Society- of Anesthesiologist grade I or II, undergoing laparoseopie myomeetomy with general anesthesia were randomly divided into two groups ： 20 patients received ultrasound-guided bilateral transverse abdominis plane block （TAP） with dexmedetomidine （ 1 μg/kg） plus 0. 25% ropivaeaine（40 mL） （group DR） after surgery, while the other 20 patients received TAP with 0. 25% ropivaeaine（40 mL） （group R）. Tramadol was used for postoperative analgesia for all the patients. Primary outcome was vis- ual analogue scale（VAS） for pain at rest and on movement at 2,6,12,24 ,and 48 h after operation. Seconding- outcomes were time to first request for analgesia, the tramadol requirement at 48 h postoperatively, VAS for eonffort, and the incidence of analgesic related side-effects after operation. Results Pain VAS scores were much lower in group DR than in group R 6 hours postoperatively at rest, as well as 2, 6, 12 hours postoperatively at movement （ P 〈 0. 05 ）. The time to first request for analgesia was longer in group DR than in group R（ P 〈 0. 05 ） , while tramadol consumption at 48 h after surgery in group DR was significantly lower than that of group R（ P 〈 0. 05 ）. Conffort VAS scores were much higher in group DR than in group R at 6, 12 h postoperatively （ P 〈 0. 05 ）. But there was no significance of the incidence of analgesic related side-effects between the two groups. Conclusion Combined dexmedetomidine and ropivaeaine for ultrasound guided bilateral TAP block can pro- long the duration of postoperative analgesia and enhance analgesic efficacy, which can improve patients＇ eonffort and promote postoperative recovery.

关 键 词：超声引导腹横肌平面阻滞 右美托咪定 罗哌卡因 

分 类 号：R614.4[医药卫生—麻醉学]