右美托咪定复合罗哌卡因右腹横肌平面阻滞用于腹腔镜子宫肌瘤剔除术后镇痛的效果评价  

Evaluation of analgesic effect of dexmedetomidine combined with ropivacaine on laparoscopic hysteromyomectomy patients usinglateral transversus abdominis plane block

作　　者：包音[1] 王古岩 王惠军[1] 李梅[1] 李芸[1] 纪存良[1] Bao Yin;Wang Guyan;Wang Huijun;Li Mei;Li Yun;Ji Cunliang(Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科

出　　处：《北京医学》2019年第8期675-678,共4页Beijing Medical Journal

摘　　要：目的研究右美托咪定(dexmedetomidine, DEX)复合罗哌卡因行腋中线入路腹横肌平面阻滞(transversus abdominis plane block, TAPB)用于腹腔镜子宫肌瘤剔除术后镇痛的效果。方法选取2018年9月至2019年3月首都医科大学附属北京同仁医院接受腹腔镜子宫肌瘤剔除术的患者60例,随机分为DEX组(D组,30例)和对照组(C组,30例),在全身麻醉插管后行超声引导下双侧TAPB,D组注射0.5μg/kg DEX+0.25%罗哌卡因共40 ml;C组则注射0.25%罗哌卡因40 ml。术后两组均行患者自控静脉镇痛(patient-controlled intravenous analgesia, PCIA),观察并记录患者术后首次按压镇痛泵的时间,术后4 h、8 h、12 h、24 h和48 h的VAS评分、BCS(Bruggrmann comfort scale)评分、术后48 h内PCIA按压次数、睡眠情况及不良反应发生率。结果 D组手术结束至首次按压镇痛泵的时间明显长于C组[(5.4±1.6)h比(2.3±1.8)h,P <0.05];与C组比较,D组术后8 h、12 h、24 h的VAS评分降低,BCS评分升高(P <0.05);除手术结束到术后4 h时间段外,其余各时间点镇痛泵按压次数D组明显少于C组(P <0.05)。两组均未观察到TAPB相关并发症。结论采用0.5μg/kg DEX复合0.25%罗哌卡因行TAPB可使腹腔镜子宫肌瘤剔除患者得到更为理想的术后多模式镇痛效果,并减少术后阿片类药物用量,且无明显不良反应。Objective To identify the postoperative analgesia effect of dexmedetomidine(DEX) with ropivacaine on laparoscopic hysteromyomectomy usinglateral transversus abdominis plane block(TAPB). Methods Sixty patients underwent laparoscopic hysteromyomectomy from September 2018 to March 2019 were randomly divided into group D and group C. Bilateral TAPB was completed with totally 40 ml 0.25% ropivacaine and 0.5 μg/kg DEX for group D and only totally 40 ml 0.25% ropivacaine for group C. Patient-controlled intravenous analgesic(PCIA) pumps were started at the end of surgery.Time elapsed for the first additional analgesia request was recorded. Visual analogue score(VAS), Bruggrmann comfort scale(BCS), frequency of PCIA pressed at 4, 8, 12, 24 and 48 h after operation, sleep quality and adverse reaction were also compared. Results Patients in both groups had no TAPB-related complication. The time elapsed for the first additional analgesia request in group D were significantly later than that in group C [(5.4±1.6)h vs.(2.3±1.8)h,P < 0.05]. Compared with group C, VAS score were significantly lower and BCS score was significantly higher at postoperative 8, 12, 24 h(P < 0.05).The frequency of PCIA pressed in group D were significantly lower than that in group C(P < 0.05). Conclusions TAPB with 0.5μg/kg DEX combined with 0.25% ropivacaine can provide more ideal multi-mode analgesic effect for patients undergoing laparoscopic myomectomy, and reduce the dosage of opioids after operation without obvious adverse reactions.

关 键 词：右美托咪定 罗哌卡因 腹横平面阻滞 腹腔镜子宫肌瘤剔除术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]