舒芬太尼复合罗哌卡因腹横筋膜阻滞用于腹腔镜胆囊切除术的镇痛效果  

Analgesic effect of sufentanil combined with ropivacaine for laparoscopic cholecystectomy

作　　者：赵晓楠[1] 关雷[1] 刘鹏飞[1] 王邵恒[1] 刘文涛[1] 陈立芳[1] 冯枫[1] 汪润[1] ZHAO Xiao-nan;GUAN Lei;LIU Peng-fei(Department of Anesthesiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院,北京100038

出　　处：《中国实验诊断学》2020年第5期739-742,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨舒芬太尼复合罗哌卡因腹横筋膜阻滞用于腹腔镜胆囊切除术的镇痛效果及安全性。方法选择60例胆囊炎患者,随机均分为观察组和对照组,择期行腹腔镜胆囊切除术。两组患者麻醉诱导前实施超声引导下行肋缘下双侧腹横筋膜阻滞。对照组患者超声引导下进行双侧腹横筋膜阻滞。确定针尖处于腹横肌与腹内斜肌之间时,回抽无血,两侧各注入0.25%罗哌卡因20ml。观察组患者,双侧均注入0.25%罗哌卡因20ml,其中混合舒芬太尼10μg。记录两组患者年龄,性别,体重指数,ASA分级,手术时间等;并于术后1h,6h,12h,24h,48h时评估静息状态和咳嗽状态下的疼痛视觉评分;记录患者入手术室后(T1),腹横筋膜阻滞完成后5min(T2),阻滞完成后20 min(T3),切皮时(T4),苏醒拔管后(T5)时的平均动脉压(MAP)及心率(HR);记录相关不良事件,包括头晕、恶心呕吐、皮肤瘙痒、局部血肿、局麻药中毒,穿破腹膜,阻滞不全等情况。结果与对照组相比,观察组患者在术后12h,24 h及48h的静息痛及运动痛评分均显著低于对照组(P<0.05);观察组患者瑞芬太尼用量及追加氟比洛芬酯的量显著少于对照组(P<0.05);两组患者基本信息及不良事件比较无统计学差异(P>0.05)。结论在腹横筋膜阻滞中,10μg舒芬太尼能够显著延长罗哌卡因的作用时间,同时无明显副作用。因而0.25%罗哌卡因40ml复合舒芬太尼20μg是安全有效的。Objective To investigate the analgesic effect and safety of sufentanil combined with ropivacaine in laparoscopic cholecystectomy.Methods 60 patients undergoing selective laparoscopic cholecystectomy were randomly divided into two groups:control group and observation group,each group containing 30 cases.Before anesthesia induction,ultrasonic-guided bilateral transverse abdominal fascia blockade was performed in the two groups.By using the inplane method,the puncture needle was inserted into the abdominal oblique muscle and transverse abdominis muscle.After determining the position of the needle,no blood was extracted,and 0.25%ropivacaine 20 ml was injected into both sides of the control group.In the observation group,0.25%ropivacaine 20 ml was injected into both sides,including 10μg of sufentanil.Age,gender,body mass index,ASA classification and operation time were recorded in the two groups.Visual score of pain at 1 h,6 h,12 h,24 hand 48 hpostoperatively in resting and coughing states;The average arterial pressure(MAP)and heart rate(HR)of the patients were recorded after entering the operating room(T1),5 min after the completion of transverse abdominal fascia block(T2),20 min after the completion of the block(T3),at the time of skin resection(T4),and at the time of resuscitation and extubation(T5).Relevant adverse events were recorded,including dizziness,nausea and vomiting,itchy skin,local hematoma,local anesthetic poisoning,peritoneum puncture,incomplete block,etc.Results Compared with the control group,pain scores in the observation group at 12 h,24 hand 48 h after surgery were significantly lower than those in the control group at rest and under cough(P<0.05).The amount of remifentanil and flurbiprofen ester in the observation group was significantly lower than that in the control group(P<0.05).There was no statistically significant difference in basic information and adverse events between the two groups(P>0.05).Conclusion It is safe and effective to use sufentanil 20μg combined with 0.25%ropivacaine 40 ml

关 键 词：舒芬太尼 罗哌卡因 腹横筋膜阻滞 腹腔镜 超声 

分 类 号：R971[医药卫生—药品]