静脉注射右美托咪定并腹直肌鞘阻滞在开腹术中应用  

APPLICATION OF INTRAVENOUS INJECTION OF DEXMEDETOMIDINE COMBINED WITH RECTUS SHEATH BLOCK IN LAPAROTOMY

作　　者：施彩凤[1] 郑露 杨晓红 初春芹[1] 王培[1] 王君涛[1] SHI Caifeng;ZHENG Lu;YANG Xiaohong;CHU Chunqin;WANG Pei;WANG Juntao(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003 [2]青岛市中医医院(市海慈医院)麻醉科

出　　处：《青岛大学学报（医学版）》2023年第2期254-258,共5页Journal of Qingdao University(Medical Sciences)

基　　金：山东省医学会舒适化医疗科研基金(YXH2020-ZX018)。

摘　　要：目的探讨静脉注射右美托咪定联合腹直肌鞘阻滞对开腹探查病人血流动力学和术后镇痛的影响。方法选择100例择期行全麻下腹部手术的病人,随机分为对照组(C组)、腹直肌鞘阻滞组(B组)、右美托咪定组(D组)、静脉注射右美托咪定和腹直肌鞘阻滞组(BD组)。全麻诱导后,C组病人切皮和关腹时静脉给予舒芬太尼;B组和BD组在超声引导下行双侧腹直肌鞘阻滞;D组和BD组静脉注射右美托咪定负荷剂量0.6μg/kg,然后以0.3μg·kg^(-1)·h^(-1)持续到手术结束。比较诱导前(T_(0))、腹膜切开时(T_(1))及腹腔探查开始5 min(T_(2))、10 min(T_(3))、15 min(T_(4))时各组病人的收缩压和心率,术后1、6、12和24 h时间点各组病人中重度疼痛和恶心呕吐的发生率。结果T 2~T 4时B组和C组病人的收缩压和心率明显高于T_(1)时(F=11.86~20.65,P<0.05),且显著高于D组和BD组(F=8.27~14.41,P<0.05)。C组术后1 h和6 h中重度疼痛病人比例显著高于B组和BD组(χ^(2)=51.45、19.53,P<0.05)。结论静脉注射右美托咪定联合腹直肌鞘阻滞应用于腹腔探查病人血流动力学更稳定,术后镇痛效果更好。Objective To investigate the effect of intravenous injection of dexmedetomidine combined with rectus sheath block on hemodynamics and postoperative analgesia in exploratory laparotomy.Methods A total of 100 patients who underwent elective lower abdominal surgery under general anesthesia were randomly divided into control group(group C),rectus sheath block group(group B),dexmedetomidine group(group D),and intravenously injected dexmedetomidine+rectus sheath block group(group BD).After induction of general anesthesia,the patients in group C were given sufentanil during skin incision and abdominal closure,and those in groups B and BD were given ultrasound-guided bilateral rectus sheath block.The patients in groups D and BD were given intravenously injected dexmedetomidine at a loading dose of 0.6μg/kg,followed by continuous infusion at a dose of 0.3μg·kg^(-1)·h^(-1)until the end of the surgery.The groups were compared in terms of systolic blood pressure(SBP)and heart rate(HR)before induction(T_(0)),at the time of peritoneum incision(T_(1)),and at 5 min(T_(2)),10 min(T_(3)),and 15 min(T 4)after the beginning of abdominal exploration,as well as the incidence rates of moderate-to-severe pain and nausea and vomiting at 1,6,12,and 24 h after surgery.Results For groups B and C,SBP and HR at T_(2)-T_(4)were significantly higher than those at T_(1)(F=11.86-20.65,P<0.05),and groups B and C had significantly higher SBP and HR than groups D and BD at T_(2)-T_(4)(F=8.27-14.41,P<0.05).At 1 and 6 h after surgery,group C had a significantly higher proportion of patients with moderate-to-severe pain than groups B and BD(χ2=51.45,19.53;P<0.05).Conclusion Intravenous injection of dexmedetomidine combined with rectus sheath block can help to achieve stable hemodynamics and good postoperative analgesia in patients undergoing abdominal exploration.

关 键 词：腹直肌 肾上腺素能α-2受体激动剂 麻醉和镇痛 

分 类 号：R614[医药卫生—麻醉学]