腹横筋膜阻滞联合右美托咪定对腹腔镜胆囊切除患者术后苏醒的影响  

Effect of transversus abdominis plane block combined with dexmedetomidine on postoperative recovery in patients undergoing laparoscopic cholecystectomy

作　　者：廖朝霞[1] 周礼生[1] 温婧 李玉娟[1] Liao Zhaoxia;Zhou Lisheng;Wen Jing;Li Yujuan(Department of Anesthesiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科

出　　处：《新医学》2019年第9期681-685,共5页Journal of New Medicine

基　　金：广东省自然科学基金（2016A030313251,2018A0303130272）

摘　　要：目的探讨腹横筋膜阻滞(TAP)联合术中右美托咪定静脉泵注对腹腔镜胆囊切除患者术后苏醒的影响.方法将80例接受腹腔镜胆囊切除患者按随机数字表法分为TAP联合右美托咪定组(TAD组)、单纯TAP组(TAP组)、单纯右美托咪定组(D组)及空白对照组(C组),每组20例.TAD组和TAP组在常规麻醉诱导后予双侧B超引导下TAP(每侧0.375%罗哌卡因20ml),TAD组和D组在术中静脉给予右美托咪定0.6μg/kg.比较各组术中瑞芬太尼、顺阿曲库铵和地氟烷使用量,自主呼吸恢复时间和拔管时间以及拔除气管导管后10min(T1)、30min(T2)、60min(T3)、4h(T4)的视觉模拟评分法(VAS)评分和Ramsay镇静评分.结果与C组比较,TAD、TAP组术中瑞芬太尼、地氟烷的用量减少(P均<0.05).与C组比较,TAD、TAP组的自主呼吸恢复时间和拔管时间均较短(P均<0.05).在T1~T4时,TAD、TAP组的VAS评分均低于C、D组(P均<0.05).在T1~T2时,TAD、TAP和D组的Ramsay镇静评分高于C组(P均<0.05);在T3时,与C组相比,TAD、TAP组的Ramsay镇静评分更高(P均<0.05);在T4时,与TAP组比较,TAD、D组的Ramsay镇静评分更高(P均<0.05).结论TAP可为腹腔镜胆囊切除术提供满意的镇痛效果,联合应用右美托咪定可以提高患者的苏醒质量.Objective To investigate the effect of combined use of transversus abdominis plane(TAP)block and dexmedetomidine on postoperative recovery in patients undergoing laparoscopic cholecystectomy.Methods According to the random number table method,80 patients were randomly and evenly assigned into the TAP combined with dexmedetomidine(TAD),TAP,dexmedetomidine(D)and control(C)groups.Patients in the TAD and TAP groups received bilateral B ultrasound-guided TAP block with 20 ml of 0.375%ropivacaine for each side after the induction of anesthesia.Patients in the TAD and D groups received intravenous infusion of dexmedetomidine at a dose of 0.6μg/kg during the surgery.Intraoperative consumption of remifentanil,cisatracurium and desflurane,the recovery time of spontaneous respiration,extubation time,the visual analogue scale(VAS)and Ramsay scores at 10 min(T1),30 min(T2),60 min(T3)and 4 h(T4)after extubation were statistically compared among different groups.Results Compared with the C group,intraoperative consumption of desflurane and remifentanil was significantly decreased in TAD and TAP groups(both P<0.05).Compared with the C group,the recovery time of spontaneous respiration and extubation time were remarkably shorter in the TAD and TAP groups(both P<0.05).At the T1-T4 time points,the VAS scores in the TAD and TAP groups were significantly lower than those in the C and D groups(all P<0.05).At T1-T2 time points,the Ramsay scores in the TAD,D and TAP groups were significantly higher than that in the C group(all P<0.05).At T3,the Ramsay scores in the TAD and TAP groups were significantly higher compared with that in the C group(both P<0.05).At T4,the Ramsay scores in the TAD and D groups were significantly higher than that in the TAP group(both P<0.05).Conclusions TAP block can yield satisfactory analgesic effect for laparoscopic cholecystectomy.TAP block in combination with dexmedetomidine can enhance the recovery quality of patients undergoing laparoscopic cholecystectomy.

关 键 词：腹横筋膜阻滞 右美托咪定 腹腔镜胆囊切除 术后苏醒 

分 类 号：R614[医药卫生—麻醉学]