DEX复合罗哌卡因TAPB用于小儿腹腔镜阑尾切除术的临床分析

目的观察右美托咪啶（DEX）复合罗哌卡因（Ropivacaine）超声引导下腹横肌平面阻滞（TAPB）对小儿腹腔镜阑尾切除术的影响。方法选择行腹腔镜阑尾切除术患儿40例随机分成两组，每组各20例。观察组在超声引导下行TAPB，注射剂量为0．4ml／kg（DEX1μg/kg＋0.3％哆哌卡因）；对照组处理同观察组，注射剂量为0．4ml／kg（0.3％哆哌卡因）。TAPB在全身麻醉实施后手术开始前实施，记录术中脑电双频谱指数（BIS）及血流动力学指标，拔除气管导管和送病房前行改良Aldrete评分、镇静评分。记录患者拔管时间、PACU滞留时间、术后不同时间点镇痛、TAPB至疼痛开始出现的时间及实验过程中不良反应发生情况。结果两组患者术后拔管时间无明显差异（P〉0．05），但观察组PACU滞留时间显著长于对照组（P〈0．05），Aldrete（T1）、Aldrete（T2）评分显著低于对照组（P〈0．05）。观察组在术后8．5h出现疼痛病例，而对照组术后6．1h出现疼痛病例，且观察组疼痛程度显著低于对照组，术后无痛时间窗显著延长（P〈0．05）；观察组在拔管即刻和出恢复室时Ramsay评分显著高于对照组（P〈0．05）。观察组术中各时间点BIS值均显著低于对照组（P〈0．05），而心率（HR）、平均动脉压（MAP）（T-5时刻除外）两组无明显差异。结论DEX复合罗哌卡因超声引导下TAPB用于腹腔镜阑尾切除可显著降低术中BIS值，但是对血流动力学（HR、MAP）无明显影响，可为患儿提供更为有效的术后镇痛，而不增加不良反应，患者满意度高。

Objective To observe the effect of dexmedetomidine combined with ropivacaine on ultrasound-guided transversus abdominis plane block for children undergoing laparoscopic appendectomy. Methods Fourty children undergoing scheduled laparoscopic appendectomy were randomized into experimental group or controlled group, with each group 20 patients. TAP block by using ultrasound guidance at a dose of 0.4ml/ kg with DEX lug/kg＋0.3% ropivacaine or 0.3% ropivacaine respectively. Ultrasound-guided TAP block was practiced under general anesthesia before surgery. Bispectral index （ BIS ） and hemodynamic parameters were recorded intraoperatively. Modified Aldrete score and sedation （ Ramsay ） score were assessed at the point of extubation and before deliveried to ward respectively. Extubation time, PACU residence time, analgesia （ Flacc ） at different time points, time interval from TAP block to pain starts and adverse effects were assessed and recorded. Results There＇ s no difference in extubation time between the two groups （ P〉0.05 ） , but PACU residence time was significantly longer in experimental group （ P〈0.05 ） . Compared with controlled group, Aldrete （ T1 ） , Aldrete （ T2 ） scores were significantly lower in experimental group （ P〈0.05 ） . Pain case was reported 8.5h after surgery in experimental group and pain free time was longer than controlled group （ P〈0.05 ） , while pain case was reported 6.1 h after surgery in controlled group and the pain degree was much higher than experimental group （ P〈0.05 ） . Ramsay scores at the time points of extubation and before deliveried to ward were significantly higher in experimental group （ P〈0.05 ） . BIS values in experimental group were significantly lower than the control group at each time point （ P〈0.05 ） , but there were no significant difference in HR and MAP （ except T-5 ） . Conclusions DEX combined with ropivacaine on ultrasound-guided transversus abdominis plane block can significantly reduce intraoperative BIS values for children undergoing laparoscopic appendectomy, provide more effective postoperative analgesia without increasing side effects, Improve patient satisfaction, but no significant effect on hemodynamics （ HR, MAP ） .