超声引导腹横肌平面右美托咪定复合罗哌卡因阻滞对下腹部手术患者镇痛效果的临床观察

Combination of dexmedetomidine and ropivacaine injection by ultrasound- guided transversus abdominis plane blocks for postoperative analgesia after lower abdominal operation

目的探讨盐酸右美托咪定（dexmedetomidine hydrochloride）复合罗哌卡因（ropivacaine）应用于超声引导腹横肌平面（transversus abdominal plane，TAP）阻滞对下腹部手术患者的镇痛效果。方法选择下腹部手术患者60例，ASA分级Ⅰ或Ⅱ级，随机分为3组（n=20）：0．75％罗哌卡因20ml＋生理盐水20ml（R组）、0．75％罗哌卡因20ml＋右美托咪定20μg＋生理盐水20ml（R＋D20组）、0．75％罗哌卡因20ml＋右美托咪定40μg＋生理盐水20ml（R＋D40组）。术后在麻醉恢复室内实施双侧TAP阻滞，每侧20ml。持续监测无创血压、心电图、呼吸、脉搏血氧饱和度。记录术后Ramsay评分、VAS评分、术后额外镇痛药使用情况及不良反应发生情况。结果各组间心率、血压、脉搏氧饱和度和Ramsay评分无明显差异（P〉0．05），R＋D20组和R＋D40组的VAS评分和额外镇痛药使用次数低于R组（P〈0．05）；3组间不良反应（恶心、呕吐、皮肤瘙痒及呼吸抑制等）无明显差别（P〉0．05）。结论右美托咪定复合罗哌卡因TAP阻滞对下腹部手术患者镇痛效果好，且右美托咪定能延长罗哌卡因镇痛时间。

Objective To evaluate the efficacy of dexmedetomidine mixed with ropivacaine for postoperative analgesia after lower abdominal operation through ultrasound -guided transversus abdominis plane blocks （TAP）. Methods Sixty ASA physical status Ⅰ or Ⅱ patients scheduled for lower abdominal operation were randomly divided into 3 groups （ n = 20 each） ： ropivacaine group （ R group）, ropivaeaine ＋ dexmedetomidine 20 Ixg group （ R ＋ D 20μg group）, ropivacaine ＋ dexmedetomidine 40 μg group （ R ＋ D 40 μg group）. Patients were randomized to receive ultrasound - guided TAP blocks using ropivacaine and/ or dexmedetomidine after operation. The Ramsay score, VAS score were recorded. The adverse events （ retention of urine, skin itching, and respiratory depression）, Hemodynamic indexes （ SBP, DBP, HR） and SaO2 were also recorded. Results There were no significant differences in Ramsay score and postoperative adverse reaction among the three groups （P 〉 0. 05 ）. Compared with R group, frequency of using additional analgesics and VAS score in R ＋ D 20 μg and R ＋ D 40 μg groups decreased significantly （ P 〈 0.05 ）. No significant difference of adverse reactions （such as nausea, vomiting, skin itching, and respiratory depression） ws observed among the three groups （ P 〉 0.05 ）. Conclusion Dexmedetomidine mixed with ropivacaine can be effectively used for postoperative analgesia after lower abdominal operation through ultrasound -guided transversus abdominis plane blocks.