非阿片类麻醉联合腹横肌平面阻滞对妇科腹腔镜术后恢复质量的影响  

Effect of opioid-free anesthesia combined with transversus abdominis plane block on the quality of recovery after gynecological laparoscopic surgery

作　　者：李清丽 武建洪 唐蕾 高国一 曾毅 LI Qingli;WU Jianhong;TANG Lei;GAO Guoyi;ZENG Yi(Department of Gynaecology,Xishuangbanna Dai Autonomous Prefecture People's Hospital,Jinghong 666100,CHINA)

机构地区：[1]西双版纳傣族自治州人民医院妇科,云南景洪666100 [2]西双版纳傣族自治州人民医院麻醉科,云南景洪666100

出　　处：《江苏医药》2025年第2期166-169,174,共5页Jiangsu Medical Journal

摘　　要：目的评估非阿片类麻醉联合腹横肌平面阻滞对妇科腹腔镜术后恢复质量的影响。方法择期行妇科腹腔镜手术患者50例随机均分为两组。C组采用常规的全身麻醉方案,麻醉诱导采用丙泊酚2.0~2.5mg/kg,顺式阿曲库铵1.5~2.0mg/kg和芬太尼2μg/kg;麻醉维持采用瑞芬太尼0.05~0.15μg·kg^(-1)·min^(-1)。OF组在麻醉诱导时使用非阿片类药物艾司氯胺酮0.3mg/kg替代芬太尼,麻醉维持使用右美托咪定0.3μg·kg^(-1)·h^(-1)替代瑞芬太尼。两组气管插管后均行0.25%罗哌卡因30mL超声引导下双侧腹横肌平面阻滞(每侧注射15mL),术中持续吸入七氟烷,静脉泵注丙泊酚5~7mg·kg^(-1)·h^(-1)维持麻醉。术后两组患者均采用相同的静脉镇痛方案。记录两组患者术后6、12、24、48h的VAS疼痛评分及术前和术后24、48h恢复质量15(QoR^(-1)5)评分。记录两组患者曲马多补救镇痛的例数及术后不良反应发生情况。结果OF组术后6、12、24、48h的VAS疼痛评分均低于C组(P<0.05)。OF组术后24、48h的QoR^(-1)5评分高于C组(P<0.05)。OF组术后恶心呕吐和睡眠障碍发生率低于C组(P<0.05)。OF组曲马多补救镇痛率低于C组(P<0.05)。结论艾司氯胺酮复合右美托咪定的非阿片类麻醉方案能够更好地缓解妇科腹腔镜手术患者的术后疼痛,改善恢复质量,降低镇痛相关不良反应发生率。Objective To evaluate the effect of opioid-free anesthesia combined with transversus abdominis plane block(TAPB)on the quality of recovery after gynecological laparoscopic surgery.Methods Fifty patients undergoing gynecological laparoscopic surgery were randomly divided into two groups with 25 cases each.Group C received conventional general anesthesia,which was induced with propofol 2.0-2.5mg/kg,cisatracurium 1.5-2.0mg/kg and fentanyl 2μg/kg,and maintained with remifentanil 0.05-0.15μg·kg^(-1)·min^(-1).Group OF received opioid-free anesthesia,which was induced with esketamine 0.3mg/kg instead of fentanyl and maintained with dexmedetomidine 0.3μg·kg^(-1)·h^(-1)instead of remifentanil as in group C.Ultrasound-guided TAPB on both sides was performed with 0.25%ropivacaine 15mL for each side after endotracheal intubation.Both groups received continuous inhalation of sevoflurane and intravenous infusion of propofol 5-7mg·kg^(-1)·h^(-1)for anesthesia maintenance.Both groups received the same intravenous analgesia regimen after surgery.The VAS pain scores at 6,12,24 and 48 hours after surgery and quality of recovery 15(QoR-15)scores before surgery and at 24 and 48 hours after surgery were evaluated.The rate of tramadol remedial analgesia and the occurrence of postoperative adverse reactions were recorded.Results The VAS pain scores of group OF at 6,12,24 and 48 hours after surgery were lower than those of group C(P<0.05).The QoR-15 scores at 24 and 48 hours after surgery in group OF were higher than those in group C(P<0.05).The incidences of postoperative nausea and vomitting and sleep disorder in group OF were lower than those in group C(P<0.05).The rate of tramadol remedial analgesia after surgery was lower in group OF than that in group C(P<0.05).Conclusion Esketamine combined with dexmedetomidine can better relieve postoperative pain after gynecological laparoscopic surgery,improve the recovery quality,and reduce the incidence of analgesia-related adverse reactions.

关 键 词：妇科 非阿片类麻醉 恢复质量 

分 类 号：R614[医药卫生—麻醉学]