右美托咪定复合腹横肌平面阻滞对腹腔镜微创手术麻醉恢复质量的影响

Effect of dexmedetomidine combined with transversus abdominis plane block on the recovery quality from anesthesia in mini4nvasive laparoscopy surgery

目的 探讨右美托咪定复合腹横肌平面阻滞（transversus abdominis plane block,TAPB）对腹腔镜微创手术麻醉恢复质量的影响.方法 选择行腹部腔镜微创手术患者114例,采用随机数字表法分为3组（每组38例）：右美托咪定组（D1组）、右美托咪定＋双侧TAPB组（D2组）、双侧TAPB组（D3组）.记录麻醉诱导前、手术开始后10 min、手术开始后30 min、手术结束时、拔除气管导管时、拔除气管导管后2 min时的MAP、HR,麻醉苏醒拔管期记录拔除气管导管时的呼吸频率（respiratory rate,RR）、手术结束至拔除气管导管时间、咳嗽评分、最大的Ricker镇静躁动评分,PACU复苏期记录残余的Ricker镇静躁动评分、疼痛分级标准数字分级法（numeric rating scales,NRS）评分、恶心呕吐评分,记录术后24 h的恢复质量评分（quality of recovery 40,QoR-40）.结果 3组在各个时间点的MAP、HR差异无统计学意义（P〉0.05）.3组间拔除气管导管时HR、手术结束至拔除气管导管的时间差异无统计学意义（P〉0.05）.麻醉苏醒期的咳嗽评分、最大的Ricker镇静躁动评分差异有统计学意义（P〈0.05）.PACU复苏期：D2组NRS评分与D1组和D3组比较差异有统计学意义（P〈0.05）,3组间残余的Ricker镇静躁动评分差异无统计学意义（P〉0.05）.QoR-40评分：D1组（182.3±1.5）分,D2组（188.9±2.3）分,D3组（179.4±1.9）分,3组间差异有统计学意义（P〈0.05）.结论 右美托咪定复合TAPB有利于降低患者麻醉苏醒期间的咳嗽和躁动的发生率,降低患者在PACU复苏期的NRS评分,提高术后24 h QoR-40评分.

Objective To investigate the effect of dexmedetomidine combined with transversus abdominis plane block （TAPB） on the quality of recovery from anesthesia in minimally invasive abdominal surgery. Methods According to random number table, 114 cases of laparoscopic minimally invasive surgery were divided into 3 groups （n=38）：dexmedetomidine group （group D1）, dexmedetomidine combined with TAPB group （group D2）, TAPB group （group D3）. MAP and HR in the 3 groups were recorded and compared at various time points：before induction, 10 min after the start of operation, 30 min after the start of operation, at the end of operation, at the time of extubation and 2 min after extubation. Respiratory rate （RR）, cough score, the maximum sedation-agitation scale at the time of the extubation and the residual sedation-agitation scale, numerical rating scale （NRS）, nausea and vomiting score. Quality of recovery 40 （QoR-40）in 24 h after operation were also recorded and compared. Results MAP and HR at various time points of 3 groups were of no statistically difference （P〉0.05）. RR after removing of the endotracheal tube, the time from the end of operation to removing of the endotracheal tube, cough score during the period of recovery time and the maximum sedation-agitation scale were not statistically significant different （P〉0.05）. NRS during the period of recovery in group D2 were statistically different with that of group D1 and group D3 （P〈0.05）, the differences of maximum sedation-agitation scale of 3 groups were not statistically significant （P〉0.05）. QoR-40 in group D1, group D2 and group D3 show statistically significant differences （P〈0.05）. Conclusions Dexmedetomidine combined with TAPB could effectively decrease cough and agitation score in recovery period from anesthesia and improve the QoR-40 in 24 h after operation.