右美托咪定混合罗哌卡因用于肋缘下腹横肌平面阻滞对接受上腹部手术患者术后睡眠质量的影响  

Effect of dexmedetomidine mixed with ropivacaine on postoperative sleep quality in patients undergoing upper abdominal surgery with OSTAPB

作　　者：孙跃峰 邓志杰 叶陆恒 李星莲 刘苏 朱珊珊[2] SUN Yuefeng;DENG Zhijie;YE Luheng;LI Xinglian;LIU Su;ZHU Shanshan(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu,China;不详)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221006 [2]徐州市肿瘤医院麻醉科,江苏徐州221018

出　　处：《实用医学杂志》2025年第7期1030-1035,共6页The Journal of Practical Medicine

基　　金：江苏省高校自然科学研究基金项目(编号:22KJA32000)。

摘　　要：目的探讨右美托咪定混合罗哌卡因用于肋缘下腹横肌平面阻滞(oblique subcostal transversus abdominis plane block,OSTAPB)对接受上腹部手术的患者术后睡眠质量的影响。方法选取徐州医科大学附属医院2024年11月至2025年1月拟接受胃部手术的患者共计140例,根据随机数字表分为单纯肋缘下腹横肌平面阻滞组(A组)和右美托咪定复合肋缘下腹横肌平面阻滞组(B组)。比较术前当晚的阿森斯失眠量表评分(Asymptomatic Sleep Disturbance Scale,AIS)和焦虑程度评分(Self-rating Anxiety Scale,SAS),术后当晚及次日的AIS评分,术中瑞芬太尼使用量,术后3 d PCA按压累计次数,术后2、6、12、24、48 h的NRS疼痛数字评分量表(Numeric Rating Scale,NRS)以及术后当晚及术后第2天的恢复质量评分(Quality of Requirements-15,QoR-15)。结果术前两组的焦虑程度以及主观睡眠质量评分差异无统计学意义(P>0.05);而术中A组瑞芬太尼的使用量与B组也差异无统计学意义(P>0.05);两组患者术后的活动时NRS评分在48 h期间差异有统计学意义(P<0.05),但是静息状态下自24 h后两组NRS评分差异无统计学意义(P>0.05);同时B组术后12 h后的PCA按压次数也明显小于A组(P<0.05);最后B组术后两晚的恢复质量(QoR-15评分)和睡眠质量明显高于A组(P<0.05)。结论右美托咪定复合罗哌卡因行肋缘下腹横肌平面阻滞不仅可以实现优于单纯使用罗哌卡因进行肋缘下腹横肌平面阻滞的术后镇痛效果,同时也可以实现术后当晚患者的睡眠质量的改善和术后恢复质量的提升,进而有助于改善患者的整体术后恢复质量。Objective To investigate the effect of dexmedetomidine combined with ropivacaine on postoperative sleep quality in patients undergoing upper abdominal surgery following Oblique Subcostal Transversus Abdominis Plane Block(OSTAPB).Methods A total of 140 patients who underwent gastric surgery at the Affiliated Hospital of Xuzhou Medical University between September 2024 and November 2024 were enrolled.According to the random number table method,they were randomly allocated into two groups:the simple subcostal transversus abdominis plane block group(Group A)and the dexmedetomidine combined with subcostal transversus abdominis plane block group(Group B),with 70 patients in each group.The study compared the Asymptomatic Sleep Disturbance Scale(AIS)scores and Self⁃rating Anxiety Scale(SAS)scores on the night before surgery,AIS scores on the night after surgery and the following day,the amount of remifentanil used during surgery,and the cumulative number of patient⁃controlled analgesia(PCA)button presses within 3 days postoperatively.Additionally,the Numeric Rating Scale(NRS)pain scores at 2 h,6 h,12 h,24 h,and 48 h post⁃surgery,as well as the Quality of Recovery⁃15(QoR⁃15)scores on the night of surgery and the second day post⁃surgery,were evaluated.Results There were no significant differences in anxiety levels or subjective sleep quality scores between the two groups prior to the operation(P>0.05).Additionally,there was no significant difference in the usage of remifentanil between Group A and Group B(P>0.05).The NRS scores for pain differed significantly between the two groups within the first 48 hours post⁃operation(P<0.05);however,no significant difference was observed in NRS scores between the two groups after 24 hours during rest.Furthermore,the number of patient⁃controlled analgesia(PCA)activations in Group B was significantly lower than that in Group A at 12 hours post⁃operation(P<0.05).Lastly,both the QoR⁃15 and sleep quality were significantly higher in Group B compared to Group A(P<0.05).C

关 键 词：右美托咪定 肋缘下腹横肌平面阻滞 上腹部手术 术后睡眠障碍 围手术期镇痛 

分 类 号：R614[医药卫生—麻醉学]