罗哌卡因联合右美托咪定行前锯肌深层平面阻滞麻醉在乳房肿块切除术中的应用价值  

Application of ropivacaine combined with dexmedetomidine for deep plane block anesthesia of anterior serratus muscle in breast mass resection

作　　者：季世洁 袁伟 杨小林[1] Ji Shijie;Yuan Wei;Yang Xiaolin(Department of Anesthesiology,Rugao People’s Hospital,Nantong 226500,China)

机构地区：[1]如皋市人民医院麻醉科,江苏南通226500

出　　处：《海军医学杂志》2024年第11期1158-1162,共5页Journal of Navy Medicine

基　　金：南通市卫生健康委员会科研立项课题(MB2019045);南通市市级科技计划(指导性)项目(MSZ19142、MSZ2022099);如皋市科技计划基金资助项目(201943)。

摘　　要：目的研究罗哌卡因联合右美托咪定行前锯肌深层平面阻滞麻醉在乳房肿块切除术中的应用价值。方法选取2020年2月至2022年2月如皋市人民医院麻醉科择期行乳房肿块切除术的患者88例为研究对象,按照随机数字表法分为罗哌卡因组(R组)、罗哌卡因联合右美托咪定组(RD组),各44例。2组诱导麻醉前均行前锯肌深层平面阻滞麻醉,R组采用罗哌卡因,RD组采用罗哌卡因联合右美托咪定。比较2组相关麻醉情况(术中丙泊酚用量、术中瑞芬太尼用量、术后24 h舒芬太尼用量、拔管时间),记录麻醉前(T0)、切皮时(T1)、手术15 min时(T2)、手术30 min时(T3)血流动力学[平均动脉压(MAP)及心率(HR)],分析术后4、8、12、24 h疼痛程度[视觉模拟量表(VAS)评分],统计不良反应发生情况。结果RD组术中丙泊酚用量、术中瑞芬太尼用量、术后24 h舒芬太尼用量少于R组,拔管时间短于R组(P<0.05);2组MAP、HR随着手术时间呈现先升高后降低趋势(P<0.05),T1、T2、T3时间点RD组MAP、HR低于R组(P<0.05);2组术后VAS评分随着时间呈现先升高后降低趋势(P<0.05),术后4、8、12、24 h RD组VAS评分低于R组(P<0.05);RD组不良反应发生率低于R组(P<0.05)。结论乳房肿块切除术中应用罗哌卡因联合右美托咪定行前锯肌深层平面阻滞麻醉能减少麻醉药用量,维持血流动力学稳定,减轻术后疼痛程度,安全性高。Objective To study the value of ropivacaine combined with dexmedetomidine for deep plane block anesthesia of anterior serratus muscle in breast mass resection.Methods A total of 88 patients who underwent elective breast mass resection in Rugao People’s Hospital from February 2020 to February 2022 were selected and divided into two groups according to the random number table,with 44 patients in each group.Before induction of anesthesia,deep plane block anesthesia of anterior serratus muscle was performed in both groups.Ropivacaine was used in group R,and ropivacaine and dexmedetomidine were used in group RD.Intraoperative propofol dosage,intraoperative remifentanil dosage,sufentanil dosage within 24 hours after operation,and extubation time were compared between the two groups.Mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia(T0),during skin incision(T1),at 15 minutes of surgery(T2),and at 30 minutes of surgery(T3).Visual analog scale(VAS)score was recorded at 4,8,12 and 24 hours after surgery.The adverse reactions were observed.Results The dosages of propofol,remifentanil and sufentanil in the RD group were less than those in the R group,and the extubation time of the RD group was shorter than that of the R group(P<0.05).MAP and HR increased first and then decreased with the operation time in both groups(P<0.05).MAP and HR in the RD group were lower than those in the R group at T1,T2 and T3(P<0.05).Postoperative VAS scores of the two groups increased first and then decreased with time(P<0.05).The VAS scores in the RD group were lower than those in the R group 4,8,12 and 24 hours after surgery(P<0.05).The incidence of adverse reactions in the RD group was lower than that in the R group(P<0.05).Conclusion Ropivacaine combined with dexmedetomidine for deep plane block of anterior serratus muscle in breast mass resection can reduce the use of anesthetics,maintain the hemodynamic stability,and reduce the degree of postoperative pain.It has high safety.

关 键 词：罗哌卡因 右美托咪定 前锯肌深层平面阻滞麻醉 乳房肿块切除术 

分 类 号：R971[医药卫生—药品]