Dex复合罗哌卡因硬膜外阻滞在LDG中的应用效果评估  

Evaluation on application effect of epidural block with DEX combined with ropivacaine in LDG

作　　者：熊莉 罗靖 彭丽佳 赵玉潮 邵建林[1] Xiong Li;Luo Jing;Peng Lijia;Zhao Yuchao;Shao Jianlin(Department of Anesthesiology,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan,650032,China;Department of Anesthesiology,The Second People's Hospital of Yibin,Yibin,Sichuan,64400,China)

机构地区：[1]昆明医科大学第一附属医院麻醉科,昆明650500 [2]宜宾市第二人民医院麻醉科

出　　处：《西南国防医药》2020年第6期541-544,共4页Medical Journal of National Defending Forces in Southwest China

基　　金：云南省科技计划项目(2017FE468-034);云南省卫生科技计划项目(2016NS043);昆明医科大学研究生创新基金资助项目(2017S018)。

摘　　要：目的观察小剂量右美托咪定(dexmedetomidine,Dex)复合罗哌卡因硬膜外阻滞用于全身麻醉下腹腔镜胃远端切除术(LDG)中麻醉效果和术后镇痛效果及安全性评估.方法回顾性研究85例因胃癌行腹腔镜下胃远端切除术的患者,均采用胸段硬膜外阻滞联合全身麻醉的麻醉方式.分为研究组和对照组:研究组右美托咪定组(D组,n=41)硬膜外注射0.3%罗哌卡因5 ml+Dex0.5μg/kg(1 ml),手术结束时追加0.3%罗哌卡因5 ml+Dex0.5μg/kg(1 ml);对照组罗哌卡因组(R组,n=38)硬膜外注射0.3%罗哌卡因5 ml+生理盐水1 ml,手术结束时追加0.3%罗哌卡因5 m]+生理盐水l m].麻醉诱导和麻醉维持方法相同,记录术中情况,比较两组患者麻醉复苏时间、自主呼吸恢复时间、气管导管拔管时间,并随访观察患者术后4h、8h、12h、24 h的VAS疼痛评分、感觉阻滞的持续时间和运动阻滞程度评分及术后麻醉相关不良反应情况.结果两组患者苏醒时间、自主呼吸恢复时间和拔管时间比较,差异无统计学意义(P>0.05),术后4h两组间VAS疼痛评分比较差异无统计学意义(P>0.05),术后8h,12 h和24hD组VAS评分低于R组(P<0.05),感觉阻滞的持续时间D组明显长于R组(P<0.05),运动阻滞程度评分差异及术后麻醉相关不良反应发生情况差异无统计学意义(P>0.05).结论小剂量Dex复合罗哌卡因硬膜外阻滞用于全身麻醉下腹腔镜胃远端切除术镇痛效果安全、确切,不良反应少,镇痛时间长于单纯应用罗哌卡因.Objective To observe the anesthetic effect and postoperative analgesia effect of epidural block with low-dose dexmedetomidine(DEX)combined with ropivacaine(ROP)in laparoscopic distal gastrectomy(LDG)under general anesthesia and perform safety evaluation.Methods A total 85 patients undergoing LDG in our hospital for gastric cancer were retrospectively analyzed and subject to thoracic epidural block combined with general anesthesia.All patients were divided into a study group(group D with dexmedetomidine,n=41)and a control group(group R with ropivacaine,n=38).The study group was epidurally administered with 5 ml of 0.3% ROP and 1ml of DEX(0.5μg/kg),with additional 5 ml of 0.3% ROP and 1 ml of DEX(0.5μg/kg)given at the end of the operation;the control group was epidurally administered with 5 ml of 0.3% ROP and 1 ml of normal saline,with additional 5ml of 0.3% ROP and 1ml of normal saline given at the end of the operation.Same methods of anesthesia induction and anesthesia maintenance were used for both groups,with intraoperative situation recorded.The time to recovery from anesthesia,time to recovery of spontaneous breathing and time to removal of tracheal catheter were compared between the two groups.VAS pain scores,duration of sensory block,Bromage score(intensity of motor block),and adverse reactions associated with postoperative anesthesia were followed-up and observed at four,eight,12,and 24 hours after the operation.Results The differences between the two groups in time to recovery from anesthesia,time to recovery of spontaneous breathing and time to removal of tracheal catheter showed no statistical significance(P>0.05).There was no statistically significant difference in VAS pain score between the two groups at four hours after the operation(P>0.05).At eight,12 and 24 hours after the operation,group D had lower VAS score than that of group R(P<0.05)and obviously longer duration of sensory block than that of group R(P<0.05).The differences in Bromage score and the incidence of adverse reactions associated w

关 键 词：硬膜外阻滞 右美托咪定 罗哌卡因 腹腔镜胃远端切除术 镇痛 评估 

分 类 号：R614.42[医药卫生—麻醉学]