右美托咪定复合罗哌卡因在腹腔镜胆囊切除术中的麻醉效果  

Anesthesic efficacy of dexmedetomidine mixed with ropivacaine for laparoscopic cholecystectomy

作　　者：田雪丹 张岩[1] 陈语霖 马子龙[2] 刘洪玮 TIAN Xue-dan;ZHANG Yan;CHEN Yu-lin(Department of Anesthesiology,Weifang Medical College,Weifang,Shandong 261053,China)

机构地区：[1]潍坊医学院麻醉学系,山东潍坊261053 [2]潍坊医学院附属医院

出　　处：《实用医药杂志》2018年第3期211-213,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨右美托咪定复合罗哌卡因在腹腔镜胆囊术中行超声引导下腹横肌平面(TAP)阻滞的作用效果。方法 60例择期行腹腔镜胆囊切除术的患者,ASA分级Ⅰ或Ⅱ级,随机分为罗哌卡因组(R组)和右美托咪定组(DR组),每组30例,两组均在麻醉诱导前行超声引导下TAP阻滞,双侧注射,每侧分别给予0.375%罗哌卡因20 ml和0.375%罗哌卡因+右美托咪定(1.0μg/kg)20 ml。观察两组患者入室后3 min(T_0)、手术开始时(T_1)、拔管时(T_2)的SBP、DBP及HR;记录患者睁眼时间及拔管时间,对比丙泊酚及瑞芬太尼的总用药量;运用视觉模拟量表(VAS)评价术后2、6、12及24 h时间点患者静息状态下的疼痛程度并记录。结果与R组相比,DR组丙泊酚和瑞芬太尼用量明显减少(P<0.05),患者睁眼时间及拔管时间缩短(P<0.05),手术开始时(T_1)、拔管时(T_2)的SBP、DBP及HR降低(P<0.05),SBP下降尤为明显。2、4、6、12、24 h时VAS疼痛评分降低(P<0.05)。结论右美托咪定复合罗哌卡因在超声引导下行TAP阻滞用于腹腔镜胆囊切除术可减少镇静药物及阿片类药物的用量,缩短患者苏醒时间,增强镇痛效果,延长术后镇痛时间。Objective To investigate the clinical anesthesic efficacy of dexmedetomidine mixed with ropivacaine for ultrasound-guided transversus abdominis plane(TAP)block in laparoscopic surgery.Methods The 60 patients(ASAⅠorⅡgrade)were randomly divided into 2 groups(n=30)to be subject to scheduled operation:group DR received ultrasound-guided bilateral TAP block with 0.375%ropivacaine plus dexmedetomidine(0.5μg/kg)20ml and group R received that with 0.375%ropivacaine 20ml in each side before anesthesia induction.The SBP,DBP and HR in two groups were observed at 3min after entering the operation room(T0),at the beginning of the operation(T1),during the extubation(T2).The postoperative recovery time,the endotracheal extubation time,the consumption of propofol and remifentanil were used and recorded.The scores of VAS in two groups were recorded at 2,4,6,12 and 24h postoperatively.Results Compared with the group R,the consumption of propofol and remifentanil decreased significantly(P<0.05),and the time for recovery and the time for removal of endotracheal tube were shortened(P<0.05).Compared with control group,the scores of VAS at 2,4,6,12 and 24 hours were lower in the group DR(P<0.05).Conclusion Mixed ropivacine with 1μg/kg dexmetomidine can reduce the propofol and remifentanil consumption,shorten the time for recovery,and prolong the duration of postoperative analgesia for ultrasound-guided TAP block in laparoscopic cholecystectomy.

关 键 词：右美托咪定 罗哌卡因 腹横肌平面阻滞 胆囊切除术 

分 类 号：R614[医药卫生—麻醉学]