右美托咪定联合罗哌卡因腹横肌膜平面阻滞在子宫切除术中的应用

Transverses abdominis plane block with dexmedetomidine and ropivacaine in hysterectomy

目的探讨右美托咪定联合罗哌卡因在超声引导腹横肌平面阻滞对子宫切除术患者牵拉反应、认知功能及谵妄的影响。方法将2015年6月至2016年12月于长江大学附属第一医院择期行开腹子宫切除术患者116例纳入本研究,按照随机数字表法分成实验组(58例)和对照组(58例),采用硬腰联合麻醉,在超声引导腹横肌平面阻滞,实验组注入0.5μg/kg右美托咪定和0.2%罗哌卡因,每侧20m L,而对照组给予同量生理盐水。观察术中患者的心率、平均动脉压及Narcotrend指数(NTI)评分等;评价患者的牵拉反应、术后认知功能及谵妄等。结果实验组在牵拉子宫时的心率明显高于对照组,在手术开始时、牵拉子宫时的NTI评分明显低于对照组,差异均有统计学意义(t值分别为4.956、2.585、2.326,均P<0.05);与对照组相比,实验组牵拉反应、舒适度及满意度评定为优的患者较多,差异均有统计学意义(χ~2值分别为11.825、19.829、4.245,均P<0.05)。所有患者均无术后认知功能障碍及谵妄。结论右美托咪定联合罗哌卡因在超声引导腹横肌平面阻滞可有效改善子宫切除术患者的牵拉反应,且不引起其认知功能障碍及谵妄发生的风险。

Objective To investigate the effects of ultrasound-guided transverses abdominis plane block with dexmedetomidine and ropivacaine on traction reaction, cognitive function and delirium in patients with abdominal hysterectomy.Methods Altogether 116 patients undergoing selective abdominal hysterectomy from June 2015 to December 2016 were included in this study and divided into experimental group （n=58） and control group （n=58） randomly.All patients received combined spinal and epidural anesthesia.In ultrasound-guided subcostal transverses abdominis plane block, patients in the experimental group were injected with 0.5μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side, and same amount of saline was used for the control group.Heart rate, mean arterial pressure and Narcotrend index（NTI）scale were recorded during operation.Effect of traction reaction, postoperative cognitive function and delirious of patients were evaluated.Results Heart rate at uterine traction of patients in the experimental group was significantly higher than that in the control group, but NTI scale at beginning of operation and uterine traction was significantly lower.All differences had statistical significance （t value was 4.956, 2.585 and 2.326, respectively, all P〈0.05）.Compared to the control group, number of patients with excellent evaluation on traction reaction, degree of comfort and satisfaction in the experimental group was significantly higher （χ2 value was 11.825, 19.829 and 4.245, respectively , all P〈0.05）.All patients had no postoperative delirium or cognitive dysfunction.Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and ropivacaine can effectively improve traction reaction and do not increase risk of cognitive dysfunction and delirium in abdominal hysterectomy.