超声引导下不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞的效果及对患者应激指标的影响

李和　吴艳琴　姜辉

[摘要] 目的 研究超聲引导下不同剂量右美托咪定联合罗哌卡因腹横肌平面阻滞的效果及对患者应激指标的影响。方法 选取2017年1～11月我院收治的需要择期经腹部行全子宫切除术的患者120例，经统计患者的ASA评分为Ⅰ级或者为Ⅱ级。随机均分为：不同剂量的右美托咪定组（A1～A3组）和对照组（B组），每组患者30例。待患者行手术后，给予A1、A2、A3组患者DEX的剂量分别为0.50 μg/kg、1.00 μg/kg、2.00 μg/kg，并加入浓度为0.25%的罗哌卡因60 mL。给予B组患者浓度为0.25%的罗哌卡因60 mL。记录手术完成后2 h、6 h、12 h、24 h患者静息或者活动时的VAS评分、Ramsay镇静评分。 结果 各组患者在术后的各个时间段无论是处于静息状态还是运动状态，均未见明显差异（P>0.05）。A组患者术后24 h、48 h芬太尼的用量均低于B组，而A1组的用量高于A2、A3组（P<0.05），A2与A3组无明显差异（P>0.05）；各组患者术前各因子的浓度无明显差异（P>0.05），术后，A1组各因子的浓度明显低于B组，A2、A3较为接近皆低于A1组（P<0.05）。 结论 超声引导下右美托咪定联合罗哌卡因腹横肌平面阻滞的效果较好，不仅可以增强术后的镇痛效果，还可以促进患者的术后恢复。这就表明浓度为1.00～2.00 μg/kg的DEX+浓度为0.25%的罗哌卡因60 mL的效果最好。

[关键词] 右美托咪定；罗哌卡因；腹横肌平面阻滞；超声引导

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）12-0102-04

Effectiveness and influence on stress indices of different doses of dexmedetomidine combined with ropivacaine guided by ultrasound in patients with transversus abdominis plane block

LI He1 WU Yanqin1 JIANG Hui1 LIN Shengxian2

1.Department of Anesthesiology， Wenzhou Peoples Hospital in Zhejiang Province， Wenzhou 325000， China； 2.Department of Anesthesiology， the First Affiliated Hospital of Wenzhou Medical University， Wenzhou 325000， China

[Abstract] Objective To investigate the effectiveness and influence on stress indices of different doses of dexmedetomidine（DEX） combined with ropivacaine guided by ultrasound in patients with transversus abdominis plane block（TAPB）. Methods 120 patients who needed to be treated with total abdominal hysterectomy in our hospital from January to November 2017 were selected and assessed as grade Ⅰ and grade Ⅱ by the scores of ASA. The patients were randomized into DEX of different doses group（group A1-A3） and control group（group B）， with 30 patients each. After the operation， patients in group A1， A2 and A3 were given DEX 0.50 μg/kg， 1.00 μg/kg and 2.00 μg/kg， along with 0.25% ropivacaine 60 mL. Patients in group B were given 0.25% ropivacaine 60 mL. VAS and Ramsay in quiescent condition or in movement 2 h， 6 h， 12 h and 24 h after operation were assessed. Results There was no significant difference no matter in quiescent condition or in movement in each period after operation in each group（P>0.05）. Consumption of fentanyl in patients of group A in 24th hour and 48th hour after operation was lower than group B， whereas consumption in group A1 was more than group A2 and A3（P<0.05）. There was no significant difference between group A2 and group A3（P>0.05）. There were no statistical differences in the levels of indices between each group before operation（P>0.05）. After operation， the levels of indices in group A1 were significantly lower than group B， while those in group A2 and A3 were similar and lower than group A1（P<0.05）. Conclusion The effectiveness of DEX combined with ropivacaine guided by ultrasound in patients with TAPB is good. It could enhance the effect of analgesic after operation and promote the recovery of patients after operation. It is suggested the effectiveness of combing 1.00-2.00 μg/kg DEX and 0.25% ropivacaine 60 mL is best.

[Key words] Dexmedetomidine； Ropivacaine； Transversus abdominis plane block； Ultrasound guidance

经腹部切口行全子宫切除术，由于损伤性较大，术后患者会感觉到剧烈的疼痛。当前，我国主要用的镇痛方法分为两种，一种为患者自控静脉镇痛法（patient-controlled intravenous analgesia，PCIA），另一种为患者自控硬膜外镇痛（patient-controued epidural analgesia，PCEA）[1]。这两种方法镇痛效果皆尚可，但随后产生的镇痛相关性的不良反应发病率较高。近年来，随着医疗技术水平的提高，超声引导下外周神经阻滞术成为麻醉和疼痛治疗领域的热门，而经过腹横肌平面（transversus abdominis plane，TAP）可以较好地阻滞前腹壁皮神经，以便为手术提供切口镇痛，这一阻滞用于下腹部手术镇痛有较好的效果已被证实[2]。然而……