右美托咪定不同给药方式联合腹横肌平面阻滞对老年患者腹腔镜胃癌根治术术后恢复的影响  

Effect of different way of dexmedetomidine administration combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic radical gastrectomy

作　　者：姚小蓉 杨玲[2] 李花 郭海鹏 Yao Xiaorong;Yang Ling;Li Hua;Guo Haipeng(School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan 030012,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第一医院麻醉科,山西太原030012

出　　处：《实用药物与临床》2023年第3期211-215,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨右美托咪定不同给药方式联合腹横肌平面阻滞(TAPB)对老年腹腔镜胃癌根治术患者术后恢复的影响。方法选择我院2021年10月至2022年8月择期行腹腔镜胃癌根治术的老年患者90例,随机分为对照组(0.33%罗哌卡因TAPB)、实验1组(0.33%罗哌卡因混合右美托咪定0.4μg/kg TAPB)和实验2组(右美托咪定静脉泵注0.4μg/kg 1 h,同时行0.33%罗哌卡因TAPB),每组30例。术后均行静脉自控镇痛(PCIA)。记录三组患者一般资料,术后2 h、6 h、12 h、24 h的视觉疼痛模拟(VAS)评分,Ramsay镇静评分,术后1 d 15项术后恢复质量量表(QoR-15)评分,患者入室(T1)、TAPB后(T2)、气腹后5min(T3)、苏醒即刻(T4)的心率(HR)、平均动脉压(MAP),PCIA使用情况。结果与对照组相比,实验1组与实验2组T2~T4时刻的HR、MAP显著降低(P<0.05),与实验1组比较,实验2组T2~T4时刻的HR、MAP下降明显(P<0.05)。实验1组与实验2组在各时刻的VAS评分均低于对照组,实验2组的术后24 h VAS评分高于实验1组,差异均有统计学意义(P<0.05)。实验1组和实验2组术后2 h、6 h及12 h的VAS评分差异无统计学意义(P>0.05)。实验1组和实验2组的Ramsay评分差异无统计学意义(P>0.05),但都低于对照组(P<0.05)。实验1组与实验2组的QoR-15评分明显高于对照组(P<0.05)。而两实验组间比较差异无统计学意义(P>0.05)。与对照组比较,实验1组及实验2组首次需要镇痛药时间延长,舒芬太尼用量及PCIA有效按压次数明显降低(P<0.05)。实验2组使用情况高于实验1组,差异有统计学意义(P<0.05)。结论右美托咪定联合罗哌卡因腹横肌平面阻滞可提高老年患者腹腔镜胃癌根治术术后恢复质量,局部给药较静脉泵注更能延长术后镇痛时间,减少术后PCIA镇痛药使用量,安全性高。Objective To investigate the effects of different methods of dexmedetomidine administration combined with transverse abdominal plane block(TAPB)on the postoperative recovery of elderly patients undergoing laparoscopic radical gastrectomy.Methods Ninety elderly patients who underwent elective laparoscopic radical gastrectomy were selected in our hospital from October 2021 to August 2022.They were randomly divided into control group(0.33%ropivacaine TAPB),experimental group 1(0.33%ropivacaine mixed with dexmedetomidine 0.4μg/kg TAPB),and experimental group 2(intravenous dexmedetomidine 0.4μg/kg for 1 h with 0.33%ropivacaine TAPB).After the surgery,all patients received patient-controlled intravenous analgesia(PCIA).General information,VAS at 2h,6h,12h and 24h postoperatively,Ramsay sedation score,QoR-15 score at 1 day postoperatively,haemodynamic indices at room entry(T1),after TAPB(T2),5 min after pneumoperitoneum(T3),immediately after awakening(T4)and the use of PCIA were recorded for the three groups.Results Compared with control group,the HR and MAP of experimental group 1 and experimental group 2 were significantly lower at T2~T4(P<0.05).Compared with experimental group 1,the HR and MAP of experimental group 2 decreased significantly at T2~T4(P<0.05).The VAS scores of experimental group 1 and experimental group 2 were lower than those of control group at each time,and the VAS of experimental group 2 was higher than that of experimental group 1 at 24 hours after operation,the difference being statistically significant(P<0.05).There was no difference in VAS scores between the two groups at 2 h,6 h,12 h after operation(P>0.05).There was no significant difference in Ramsay scores between the two experimental groups(P>0.05),but they were lower than those in control group(P<0.05).The QoR-15 scores of experimental group 1 and experimental group 2 were significantly higher than those of control group(P<0.05).There was no significant difference between the two experimental groups(P>0.05).Compared with control group,t

关 键 词：右美托咪定 腹横肌平面阻滞 腹腔镜胃癌根治术 术后镇痛 恢复质量 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]