罗哌卡因用于腹横肌平面阻滞在老年患者术后镇痛最佳浓度的临床研究

Clinical study of the best concentration of ropivacaine for transversus abdominis plane block analgesia in elderly patients with postoperative

目的通过不同浓度罗哌卡因对老年患者腹横肌平面阻滞(TAPB)腹部手术术后镇痛效果和安全性的观察,探讨合理的浓度。方法选择手术并采用TAPB法镇痛的老年患者100例,随机分为4组。每组罗哌卡因浓度不同:A组0.125%;B组0.25%;C组0.375%;D组0.5%,用药量均为0.5 ml/kg。观察患者术后VAS评分、术后48小时爆发疼痛次数、追加药物次数和不良反应例数。结果 C组与A、B组相比,术后VAS疼痛评分大幅下降,比较差异有统计学意义(P<0.05);C组与D组相比,差异无统计学意义;A组术后48小时爆发疼痛8次;B组术后48小时爆发疼痛2次;C组术后48小时爆发疼痛共3次;D组术后48小时爆发疼痛4次。C组疼痛爆发次数明显低于A组,差异有统计学意义(P<0.05),而与B、D两组相比差异无统计学意义;ABCD 4组的追加药物次数及术后不良反应比较差异无统计学意义。结论罗哌卡因的使用浓度为0.375%时,对老年人腹横肌平面阻滞镇痛的效果最佳,且没有明显不良反应。

Objective The different concentration of ropivacaine in elderly patients with transversus abdominis plane block(TAPB) to observe the analgesic effect and safety of abdominal surgery,to explore the reasonable concentration.Methods 100 elderly patients who had been operated on and used TAPB analgesia were randomly divided into 4 groups.The concentration of ropivacaine in each group was different: group A was0.125%,group B was 0.25%,group C was 0.375%,group D was 0.5%,and the dosage was 0.5 ml/kg.The patients' VAS score,the number of pain in48 hours after operation,the number of additional drugs and the number of adverse reactions were observed.Results C and A,B group,postoperative VAS pain score decreased significantly,the difference was statistically significant(P<0.05); there was no significant difference between group C and group D; A group broke out pain 8 times in 48 hours after operation; B group broke out pain 2 times in 48 hours after operation; C group broke out pain 3 times in 48 hours after operation,D group broke out pain 4 times in 48 hours after operation.The number of pain outbreaks in group C was significantly lower than that in group A(P<0.05),while there was no statistical difference between group two and group B and D.There was no significant difference in the number of times of adding drugs and adverse reactions after ABCD between the 4 groups.Conclusion Using the concentration of ropivacaine was 0.375%,for the elderly transversus abdominis plane block analgesia effect,and no obvious adverse reaction.