右美托咪定作为罗哌卡因佐剂在腹腔镜肾部分切除术中的应用  

Dexmedetomidine as an adjuvant for ropivacaine in laparoscopic partial nephrectomy

作　　者：马晓君 阮孝国[2] 贾佳[2] 张加强 MA Xiao-jun;RUAN Xiao-guo;JIA Jia;ZHANG Jia-qiang(Department of Anesthesiology and Perioperative Medicine,People’s Hospital Henan University,Zhengzhou 450003,China;Department of Anesthesiolo⁃gy and Perioperative Medicine,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院麻醉与围术期医学科,郑州450003 [2]河南省人民医院麻醉与围术期医学科,郑州450003

出　　处：《临床药物治疗杂志》2020年第5期74-77,共4页Clinical Medication Journal

基　　金：ERAS临床路径APP的开发与临床应用研究(项目编号:SB201901090)。

摘　　要：目的旨在探讨右美托咪定在腹腔镜肾部分切除术中作为局麻药佐剂的应用效果。方法筛选择期在河南大学人民医院行腹腔镜下肾部分切除术的患者,随机分成5组,分别为全麻对照组(BC组)、右美托咪定混合罗哌卡因进行胸椎旁神经阻滞组(NPVB组)、静脉注射右美托咪定合并胸椎旁神经阻滞组(SPVB组)、胸椎旁神经阻滞组(PVB组)和静脉注射右美托咪定组(SDEX组)。记录各组不同麻醉方法手术过程中不良事件的发生、术后苏醒时间、拔管时间、术后补救镇痛的发生率等。结果右美托咪定混合罗哌卡因胸椎旁神经阻滞组(NPVB组)的苏醒时间为(19.56±4.93)min,为5组中时间最短(P<0.05);同时,该组的术后镇痛依据视觉模拟评分法评分为(2.11±0.93)分,低于其他4组,说明镇痛效果最好,差异有统计学意义(P<0.05)。但是在术后的镇静评分方面,5组间差异无统计学意义(P>0.05)。结论右美托咪定作为罗哌卡因的佐剂进行胸椎旁神经阻滞是一种可供临床选择的优化麻醉策略,术后镇痛效果良好。Objective This study was designed to investigate the effect of dexmedetomidine as a local anesthetic adjuvant during the laparoscopic partial nephrectomy.Methods Patients who underwentlaparoscopic partial nephrectomy at the People’s Hospital of Henan University were randomly divided into 5 groups:the general anesthesia blank control group(BC group),dexmedetomidine and ropivacaine for parathoracic nerveblock group(NPVB group),intravenous dexmedetomidine combined with parathoracic nerve block(SPVB group),thoracic paravertebral nerve block group(PVB group),and intravenous dexmedetomidine group(SDEX group).Relevant data were recorded including the occurrence of adverse events during the operation of different anesthesia methods in each group,the time of postoperative recovery,the time of extubation,and the incidence of postoperative analgesia.Results The recovery time of dexmedetomidine mixed with ropivacaine in thoracic paravertebral nerve block group(NPVB group)was(19.56±4.93)min,which was the shortest in 5 groups(P<0.05);meanwhile,the post-analgesic score was 2.11±0.93 according to the visual analogue scoring method,which was lower than those of the other 4 groups,indicating that the analgesic effect was the best,and the difference was statistically significant(P<0.05).However,in terms of postoperative sedation Ramsay score,the differences between the 5 groups were not statistically significant(P>0.05).Conclusion Dexmedetomidine as an adjuvant of ropivacaine for thoracic paravertebral nerve block is a clinically optimal anesthetic strategy.It can provide good analgesia for the perioperative period.

关 键 词：右美托咪定 局麻药 胸椎旁神经阻滞 佐剂 肾部分切除术 

分 类 号：R614[医药卫生—麻醉学] R699.2[医药卫生—外科学]