右美托咪定超前镇痛联合腹横肌平面阻滞在结肠癌术后镇痛的适宜剂量探讨  

Study on the appropriate dose of dexmedetomidine leading analgesia combined with transverse abdominal plane block for postoperative analgesia in colon cancer

作　　者：孙岸灵[1] 惠强 陈思佳 罗德兴[1] 林晓峰[1] SUN An-ling;HUI Qiang;CHEN Si-jia;LUO De-xing;LIN Xiao-feng(Department of Anesthesiology,Huizhou Central People's Hospital,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院麻醉科,广东惠州516001

出　　处：《海南医学院学报》2021年第16期1223-1228,共6页Journal of Hainan Medical University

基　　金：国家自然科学基金资助项目(81803951);广东省医学科学技术研究基金资助项目(B2013409)。

摘　　要：目的:探讨右美托咪定超前镇痛联合腹横肌平面阻滞在结肠癌术后镇痛的适宜剂量。方法:选择2018年3月~2019年10月期间120例于本院择期行腹腔镜下结肠癌根治术患者,按照给予不同右美托咪定剂量随机分为对照组(C组,未给予右美托咪定)、低剂量组(L组,0.5μg/kg)、中剂量组(M组,1μg/kg)和高剂量组(H组,1.5μg/kg),每组各30例。比较患者术后2 h(T0)、4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)时平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)、视觉模拟量表(visual analog scale,VAS)疼痛评分、Ramsay评分。测量患者术后T4、T5、72 h(T6)时切口机械性刺激疼痛敏感面积。比较患者术后不良反应情况。结果:与C组相比,L、M、H组各时点MAP、HR均有不同程度降低;M、H组MAP、HR在不同时点不同程度的低于L组(P<0.05)。L、M、H组T0~T5时VAS评分、T4~T6疼痛敏感面积均明显低于C组(P<0.05),各组Ramsay评分无显著差异(P>0.05);M、H组VAS评分、疼痛敏感面积均低于L组(P<0.05)。L、M、H组术后不良反应发生率均低于C组(P<0.05)。结论:右美托咪定使用剂量为1μg/kg和1.5μg/kg时均具有良好的镇痛效果且不会增加不良反应发生率,推荐使用1μg/kg右美托咪定作为罗哌卡因行TAP阻滞时的辅助药物剂量更为合适。同时需要加强监护,避免低血压、心动过缓等不良反应。Objective:To investigate the appropriate dose of dexmedetomidine analgesia combined with transverse abdomi⁃nal plane block for postoperative analgesia in colon cancer.Methods:A total of 120 patients who underwent laparoscopic colon can⁃cer radical surgery in our hospital during March 2018-October 2019 were selected and randomly divided into the control group(group C,no dexmedetomidine),the low-dose group(group L,0.5μg/kg),the medium-dose group(group M,1μg/kg)and high-dose group(group H,1.5μg/kg)according to different doses of dexmedetomidine,with 30 cases in each group.The mean arterial pressure(MAP),heart rate(HR),visual analog scale(VAS)pain score and Ramsay score at 2 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)were compared.The pain-sensitive area of mechanical incision stimulation at T4,T5,and 72 h(T6)after surgery was measured.The postoperative adverse reactions were compared.Results:Compared with group C,MAP and HR in groups L,M and H decreased to different degrees.MAP and HR in M and H groups were lower than those in L group in different degrees at different time points(P<0.05).VAS score at T0-T5 and pain sensitive area at T4-T6 in L,M and H groups were significantly lower than those in group C(P<0.05),and there was no significant difference in Ramsay score in each group(P>0.05).The M and H groups(P<0.05)had lower VAS scores and pain-sensitive areas than L group(P<0.05).The incidence of postoperative adverse reactions in L,M,and H groups was lower than that in C group(P<0.05).Con⁃clusion:Dexmedetomidine at 1μg/kg and 1.5μg/kg has a good analgesic effect without increasing the incidence of adverse reac⁃tions.It is recommended to use 1μg/kg dexmedetomidine as an adjuvant to ropivacaine for TAP block.

关 键 词：右美托咪定 腹横肌平面阻滞 结肠癌 镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]