右美托咪定不同用药方式复合腰方肌阻滞对腹膜后腹腔镜手术术后镇痛的影响  

Effect of different routes of administration for dexmedetomidine combined with quadratus lumborum block on analgesia af⁃ter retroperitoneal laparoscopic surgery

作　　者：蒋蕴茹 高寒 刘泓妍 王清峰 张丽 赵林林 Jiang Yunru;Gao Han;Liu Hongyan;Wang Qingfeng;Zhang Li;Zhao Linlin(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]徐州医科大学附属医院麻醉科,徐州221002

出　　处：《国际麻醉学与复苏杂志》2023年第8期827-833,共7页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省高等学校自然科学研究项目(19KJB310001)。

摘　　要：目的比较右美托咪定作为局麻药佐剂或静脉使用对行腰方肌阻滞(quadratus lumborum block,QLB)的腹膜后腹腔镜手术患者术后镇痛的影响。方法择期行腹膜后腹腔镜手术的患者88例,按随机数字表法分为3组:罗哌卡因组(R组,30例)、右美托咪定作为罗哌卡因佐剂组(RD组,29例)和右美托咪定静脉使用复合罗哌卡因组(RDiv组,29例)。3组患者均于麻醉诱导前30 min行QLB,R组及RDiv组使用0.375%罗哌卡因30 ml,RD组使用混有1μg/kg右美托咪定的0.375%罗哌卡因30 ml。手术开始前15 min,RDiv组输入1μg/kg右美托咪定50 ml,R组及RD组输入生理盐水50 ml。3组其他麻醉用药相同且术后均使用患者自控静脉镇痛(patient⁃controlled intravenous analgesia,PCIA)。记录术后有效镇痛时间,术后2、6、12、24、48 h静息及运动VAS疼痛评分;记录术中丙泊酚及瑞芬太尼用量、术后48 h内PCIA有效按压次数及PCIA舒芬太尼消耗量;记录术后补救镇痛人数、术后48 h 15项恢复质量(15⁃item Quality of Recovery,QoR⁃15)量表评分、术后首次排气时间、术后首次下床时间、术后住院时间、术后不良反应(心动过缓、低血压、恶心呕吐)发生情况、术后2 h Ramsay镇静评分和下肢肌力。结果RD组术后有效镇痛时间明显长于R组和RDiv组(P<0.05),R组和RDiv组术后有效镇痛时间差异无统计学意义(P>0.05)。RD组术后6、12、24 h静息VAS疼痛评分及术后2、6、12 h运动VAS疼痛评分均低于R组(P<0.05),RDiv组术后2、6 h静息VAS疼痛评分及术后2 h运动VAS疼痛评分均低于R组(P<0.05),RD组与RDiv组间术后2、6、12、24、48 h静息及运动VAS疼痛评分差异均无统计学意义(P>0.05)。RD组术后48 h内PCIA有效按压次数及PCIA舒芬太尼消耗量低于R组和RDiv组(P<0.05),RD组术后48 h QoR⁃15量表评分高于R组(P<0.05)。3组术中丙泊酚及瑞芬太尼用量、术后补救镇痛人数、术后首次排气时间、术后首次下床时间、术后�Objective To evaluate the effects of dexmedetomidine as a local anesthetic adjunct or intravenous infusion of dexmedetomidine on postoperative analgesia after retroperitoneal laparoscopic surgery under quadratus lumborum block(QLB).Methods A total of 88 patients who were scheduled for retroperitoneal laparoscopic surgery were selected.According to the random number table method,they were divided into three groups:a ropivacaine group(group R,n=30),a dexmedetomidine as an adjuvant to ropivacaine group(group RD,n=29)and an intravenous infusion of dexmedetomidine combined with ropivacaine group(group RDiv,n=29).All patients underwent QLB 30 min before anesthesia induction.Patients in group R and group RDiv were injected with 30 ml of 0.375%ropivacaine,while those in group RD were injected with 1μg/kg dexmedetomidine combined with 30 ml of 0.375%ropivacaine.Then,15 min before the surgery,group RDiv was injected with 50 ml of 1μg/kg dexmedetomidine,while group R and group RD were given 50 ml normal saline.The same other anesthetics were given in the three groups and all the patients were subject to patient⁃controlled intravenous analgesia(PCIA)after surgery.Then,the effective duration of analgesia,Visual Analogue Scale(VAS)scores at rest and during movement at postoperative 2,6,12,24 h and 48 h were recorded.The intraoperative consumption of propofol and remifentanil were recorded.The consumption of sufentanil and effective pressing times of PCIA within 48 h after surgery were recorded.The number of patients with remedial analgesia,15⁃item Quality of Recovery(QoR⁃15)scores 48 h after surgery,the time to first exhaust and the time to first postoperative off⁃bed activity,the length of postoperative hospitalization stay,postoperative adverse reactions(bradycardia,hypotension,nausea and vomiting),Ramsay sedation scores and lower extremity muscle strength 2 h after surgery were recorded.Results The effective duration of analgesia in group RD was significantly longer than those in group R and group RDiv(P<0.05).The

关 键 词：腰方肌阻滞 右美托咪定 罗哌卡因 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]