右美托咪定复合罗哌卡因行腹横肌平面阻滞对直肠癌术后快速康复的影响

Effect of Transversus Abdominis Plane Blocking by Dexmedetomidine Combined with Ropivacaine on Rapid Recovery in Postoperative Patients with Rectal Cancer

目的观察右美托咪定复合罗哌卡因行腹横肌平面阻滞对直肠癌患者术后快速康复的影响。方法选择2015年6月—2016年1月收治的实施择期腹腔镜直肠癌根治术的患者79例。随机分为观察组39例和对照组40例。观察组给予右美托咪定、罗哌卡因,对照组给予罗哌卡因。记录2组术后4、6、8、24、48 h静息、活动时的疼痛视觉模拟(VAS)评分和Ramsay评分,记录感觉阻滞维持时间、术后首次镇痛泵按压时间、术后24 h内有效按压次数和48 h内补救镇痛比例,离床活动时间、流食恢复时间、排气和排便时间、术后住院时间。结果观察组术后6、8 h静息和活动时VAS评分低于对照组(P <0. 05); 2组Ramsay评分比较差异无统计学意义(P> 0. 05)。观察组术后感觉阻滞维持时间、首次镇痛泵按压时间长于对照组,术后24 h内有效按压次数少于对照组,术后48 h内补救镇痛比例低于对照组(P <0. 05)。观察组离床活动时间、排气和排便时间、流食恢复时间早于对照组(P <0. 05)。观察组不良反应发生率低于对照组(P <0. 05),且观察组无右美托咪定相关不良反应。结论右美托咪定复合罗哌卡因行TAP阻滞,可优化术后镇痛效果,加速胃肠功能恢复,且不增加不良反应。

Objective To observe effect of transversus abdominis plane blocking by Dexmedetomidine combined with Ropivacaine on rapid recovery in postoperative patients with rectal cancer. Methods A total of 79 patients with selective laparoscopic radical resection of rectal carcinoma were randomly divided into observation group （ n = 39） and control group （n = 40）. Observation group was treated with Dexmedetomidine and Ropivacaine, while control group was treated with Ropivacaine. In two groups, values of visual analogue scales （VAS） and Ramsay scores in postoperative 4th, 6th , 8th , 12th , 24th and 48th hours at rest and in activity were recorded, and maintaining time of feeling blocking, the first time of pressing analgesia pump, effective pressing numbers within postoperative 24 h, ratio of analgesic remediation within postoperative 48 h, ambulation time, starting time of eating liquid diet, exsufflation and defaecation times and postoperative hospitalization duration were recorded. Results VAS scores in 6th and 8th hours at rest and in activity in observation group were significantly lower than those in control group （P 〈 0.05）. There was no significant difference in Ramsay score between two groups （P 〉 0.05）. Compared with those in control group, in observation group, maintaining time of feeling blocking and the first time of pressing analgesia pmnp were significantly longer, and values of effective pressing numbers within postoperative 24 h and ratio of analgesic remediation wilhin postoperative 48 h were significantly lower （P 〈 0.05）. Ambulation time, exsufflation and defaeeation times and starting time of eating liquid diet in observa- tion group were significantly earlier than those in control group （P 〈 0.05）. Incidence rate of adverse reactions in obser- vation group was significantly lower than that in control group （P 〈 0.05）. No related-Dexmedetomidine adverse reactions was found in observation group. Conclusion Transversus abdominis plane blocking by Dexmedetomidine combined with Ropivaeaine may optimize effect of postoperative analgesia and improve recovery of gastrointestinal function without increasing adverse reactions.