超声引导下腹横肌平面阻滞联合右美托咪定麻醉对黏膜下子宫肌瘤切除术患者疼痛应激和胃肠道功能影响  

Effects of ultrasound guided transversus abdominis plane block combined with dexmedetomidine anesthesia used in the submucosal hysteromyomectomy of patients on their pain stress and gastrointestinal function

作　　者：齐鹏亮 叶丹丽 陈小龙 林慧雯 QI Pengliang;YE Danli;CHEN Xiaolong;LIN Huiwen(The Siath People's Hospital of Chengdu,Chengdu,Sichuan Province,610051)

机构地区：[1]四川省成都市第六人民医院,610051

出　　处：《中国计划生育学杂志》2025年第3期591-595,共5页Chinese Journal of Family Planning

摘　　要：目的:探究超声引导下腹横肌平面阻滞联合右美托咪定对黏膜下子宫肌瘤切除术后患者疼痛应激和胃肠道功能的影响。方法:纳入2018年3月-2021年5月本院行腹腔镜黏膜下子宫肌瘤切除术治疗的患者78例,根据麻醉方式的不同分为观察组37例(超声引导下腹横肌平面阻滞联合右美托咪定麻醉)及对照组41例(持续泵注右美托咪定)。比较两组麻醉效果、肛门排气时间、定向力恢复时间等及术中平均动脉压(MAP)、心率(HR)、手术前后疼痛应激指标、麻醉相关不良反应发生率。结果:观察组术中Ramsay分级优于对照组,气腹前、气腹后1h、气管拔管即刻、气管拔管后的MAP及HR均低于对照组;术后1d、3d时血清去甲肾上腺素(253.29±23.61μg/L、197.16±24.07μg/L)、皮质醇(131.85±18.62μg/L、106.67±21.08μg/L)、前列腺素2(18.53±2.39ng/L、16.09±2.05ng/L)、P物质(161.28±21.52ng/L、145.97±19.61ng/L)水平均低于对照组,肛门排气时间(21.31±2.67h)及定向力恢复时间(9.37±1.85min)均短于对照组(均P<0.05);麻醉相关不良反应观察组(5.4%)与对照组(9.8%)无差异(P>0.05)。结论:将超声引导下腹横肌平面阻滞联合右美托咪定应用黏膜下子宫肌瘤切除术中,可提高麻醉效果,抑制疼痛介质释放,降低应激反应,并能促进术后胃肠道功能恢复,未增加麻醉相关不良反应。Objective:To explore the effects of ultrasound-guided transversus abdominis plane block combined with dexmedetomidine used during the submucosal hysteromyomectomy of patients on their pain stress and gastrointestinal function.Methods:78 patients who wanted laparoscopic submucosal hysteromyomectomy were enrolled as the research objects between March 2018 and May 2021.According to the different anesthesia methods,these patients were divided into observation group(37 patients with ultrasound-guided transversus abdominis plane block combined with dexmedetomidine for anesthetia during surgery)and control group(41 patients with continuous pump injection of dexmedetomidine for anesthetia during surgery).The anesthesia effect,anal the exhaust time,the orientation recovery time,the values of intraoperative mean arterial pressure(MAP)and heart rate,the pain stress indexes before and after surgery and the incidence of anesthesia-related adverse reactions rate of the patients were compared between the two groups.Results:The intraoperative Ramsay grading of the patients in the observation group was significantly better than that of the patients in the control group.The values of the MAP and HR of the patients in the observation group before pneumoperitoneum,in I h after pneumoperitoneum,immediately after tracheal extubation and after tracheal extubation were significantly lower than those of the patients in the control group.The levels of the serum norepinephrine(253.29±23.61μg/L and 197.16±24.07μg/L),cortisol(131.85±18.62μg/L and 106.67±21.08μg/L)an prostaglandin 2(18.53±2.39 ng/L and 16.09±2.05 ng/L)and substance P(161.28±21.52 ng/L and 145.97±19.61 ng/L)of the patients in the observation group in the lst day and in the 3rd day after operation were significantly higher than those of the patients in the control group.The anal exhaust time(21.31±2.67h)and the orientation recovery time(9.37±1.85min)of the patients in the observation group were significantly shorter than those of the patients in the control group(

关 键 词：黏膜下子宫肌瘤 子宫肌瘤切除术 麻醉 超声引导下腹横肌平面阻滞 右美托咪定 疼痛应激 胃肠道功能 疼痛介质 不良反应 

分 类 号：R73[医药卫生—肿瘤]