右美托咪定复合罗哌卡因行后路腰方肌阻滞在剖宫产术后镇痛中的应用  

Application of Dexmedetomidine Combined with Ropivacaine for Posterior Lumborum Quadratus Block in Postoperative Analgesia of Cesarean Section

作　　者：刘晓飞[1,2] 栗俊青 赫建帅 牛雷[2] 王士雷[1] LIU Xiao-fei;LI Jun-qing;HE Jian-shuai;NIU Lei;WANG Shi-lei(Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao 266555, Shandong, China;Department of Anesthesiology, Laiwu Central Hospital, Xinwen Mining Group, Jinan 271104, Shandong, China;Department of Ultrasound, Jinan Second Maternal and Child Health Hospital, Jinan 271100, Shandong, China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266555 [2]新汶矿业集团莱芜中心医院麻醉科,山东济南271104 [3]济南市第二妇幼保健院超声科,山东济南271100

出　　处：《中国现代手术学杂志》2021年第1期65-69,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的观察右美托咪定复合罗哌卡因行后路腰方肌阻滞在剖宫产术后镇痛中的应用效果及不良反应。方法选择在蛛网膜下腔阻滞下行子宫下段横切口剖宫产术的产妇90例,ASAⅠ级或Ⅱ级,按随机数字表法分为对照组(I组)、观察组1(Q组)、观察组2(QD组),每组患者30例。三组术毕均行静脉自控镇痛,PCIA泵配方为:枸橼酸舒芬太尼1.5μg/kg+地佐辛注射液0.2 mg/kg+盐酸昂丹司琼注射液8 mg,用生理盐水稀释至100 ml,背景输注量2 ml/h,单次剂量2 ml,锁定时间15 min。Q组和QD组术后即刻在超声引导下行双侧后路腰方肌阻滞。每侧腰方肌阻滞的药物配方:Q组为0.25%罗哌卡因20 ml,QD组为0.25%罗哌卡因+右美托咪定0.5μg/kg,共20 ml。记录三组产妇术后4 h、8 h、12 h、24 h、36 h、48 h静息及运动时疼痛评分、48 h内静脉自控镇痛泵的有效按压次数、镇痛满意度评分及不良反应情况。结果术后4 h、8 h、12 h、24 h,Q组和QD组在静息和运动时VAS评分均明显低于I组,差异有统计学意义(P<0.05);术后24 h、36 h、48 h,QD组静息和运动时VAS评分均低于Q组和I组,差异有统计学意义(P<0.05);术后36 h、48 h,Q组和I组静息和运动时VAS评分比较无统计学差异(P>0.05)。QD组48 h内PCIA有效按压次数明显少于Q组和I组,镇痛满意度评分明显高于Q组和I组,总不良反应率明显低于Q组和I组,差异均有统计学意义(P<0.05)。结论右美托咪定复合罗哌卡因行后路腰方肌阻滞联合静脉自控镇痛,可为剖宫产术后患者获得更长时间且更完善的镇痛效果,减少了阿片类药物的用量及不良反应,提高患者的满意度。Objective To evaluate the application effect and adverse reactions of dexmedetomidine hydrochloride combined with ropivacaine for lumbar quadratus block(LQB)in postoperative analgesia of cesarean section.Methods A total of 90 parturient women with ASAⅠorⅡperformed lower uterine segment transverse incision cesarean section under subarachnoid block were selected and divided into control group(group I),observation group 1(Group Q)and observation group 2(Group QD)randomly according to the random number table method,with 30 cases in each group.Patient-controlled intravenous analgesia(PCIA)was performed in all three groups,with analgesic pump liquid formula as follows:Sufentanil citrate 1.5μg/kg,dezocine injection 0.2 mg/kg and ondansetron hydrochloride injection 8 mg was diluted to 100 ml with normal saline,and the background infusion volume was 2 ml/h with once 2 ml,and the locking time was 15 min.Bilateral posterior QLB was performed immediately under ultrasound guidance after the operation in group Q and group QD.The drug formula of each side of QLB was 20 ml of 0.25%ropivacaine in Group Q,and 20 ml of 0.25%ropivacaine plus dexmedetomidine 0.5μg/kg in QD group.The pain score of resting and activity at 4,8,12,24,36,48 h after the operation,the effective pressing times and analgesic satisfaction scores of PCIA and the adverse reactions within 48 h were recorded and compared.Results At 4,8,12 and 24 hours after the operation,the VAS scores of both group Q and group QD were significantly lower than those of group I at rest and exercise(P<0.05);at 24,36 and 48 hours after the operation,the VAS scores of group QD was lower at rest and exercise than those of both group Q and I(P<0.05),but there was no significant difference in VAS score between group Q and group I at rest and exercise at 36 and 48 hours after operation(P>0.05).Compare to group Q and group I,the effective PCIA pressing times were less,the analgesic satisfaction score was higher and the total adverse reaction rate was lower in group QD within 48 h,and

关 键 词：超声引导 腰方肌阻滞 右美托咪定 剖宫产术 术后镇痛 

分 类 号：R616.4[医药卫生—外科学]