不同剂量右美托咪定在腹腔镜卵巢切除术患者罗哌卡因腹横肌平面阻滞中的术后镇痛作用研究

The analgesic effect of different doses of dexmedetomidine in ropivacaine transversus abdominis plane block for patients undergoing laparoscopic oophorectomy

目的探讨不同剂量右美托咪定在腹腔镜卵巢切除术患者罗哌卡因腹横肌平面阻滞中的术后镇痛作用。方法208例在本院行腹腔镜卵巢切除术的患者,经随机数字表法分为对照组、研究1组、研究2组、研究3组,每组52例。行腹横肌平面阻滞时,对照组注射40 ml的0.375%罗哌卡因,研究1组、研究2组、研究3组分别注射0.375%罗哌卡因+0.5μg/kg右美托咪定、0.375%罗哌卡因+1.0μg/kg右美托咪定、0.375%罗哌卡因+1.5μg/kg右美托咪定的混合溶液。比较四组患者24 h羟考酮消耗量,术后6、12、24 h的视觉模拟评分法(VAS)评分,不良反应发生率。结果研究1组、研究2组、研究3组的24 h羟考酮消耗量分别为(8.03±2.08)、(5.88±1.67)、(4.78±1.59)mg,均低于对照组的(8.98±2.15)mg,且研究2组低于研究1组,研究3组低于研究2组,差异均具有统计学意义(P<0.05)。腹横肌平面阻滞后6、12、24 h,对照组的VAS评分分别为(5.43±1.06)、(4.32±0.81)、(3.22±0.79)分,研究1组的VAS评分分别为(4.67±1.02)、(3.22±0.78)、(2.54±0.77)分,研究2组的VAS评分分别为(3.54±0.78)、(2.78±0.74)、(2.03±0.69)分,研究3组的VAS评分分别为(2.64±0.77)、(2.15±0.68)、(1.45±0.57)分。腹横肌平面阻滞后6、12、24 h,研究3组患者VAS评分均低于研究2组、研究1组及对照组;四组患者腹横肌平面阻滞后24 h的VAS评分均低于本组腹横肌平面阻滞后6、12 h,差异均具有统计学意义(P<0.05)。研究1组、研究2组不良反应发生率略高于对照组,但差异无统计学意义(P>0.05),研究3组不良反应发生率高于研究2组,差异具有统计学意义(P<0.05)。结论腹腔镜卵巢切除术后罗哌卡因腹横肌平面阻滞中加用不同剂量右美托咪定,在减少羟考酮消耗量的同时,保持较好的术后镇痛效果,其中1μg/kg右美托咪定为最佳剂量,镇痛作用突出且更佳安全。

Objective To discuss the analgesic effect of different doses of dexmedetomidine in ropivacaine transversus abdominis plane(TAP)block for patients undergoing laparoscopic oophorectomy.Methods 208 patients received laparoscopic oophorectomy in our hospital were randomly divided into control group,study group 1,study group 2 and study group 3,with 52 cases in each group.During transverse abdominal plane block,patients in the control group received injection of 40 ml of 0.375%ropivacaine,while patients in the study groups 1,2 and 3 received injection of mixtures of 0.375%ropivacaine+0.5μg/kg dexmedetomidine,0.375%ropivacaine+1.0μg/kg dexmedetomidine,0.375%ropivacaine+1.5μg/kg dexmedetomidine,respectively.The 24 h oxycodone consumption,visual analogue scale(VAS)scores at 6,12 and 24 h after operation and the incidence of adverse reactions were compared among the four groups.Results The 24 h oxycodone consumption of study groups 1,2 and 3 were(8.03±2.08),(5.88±1.67),(4.78±1.59)mg,respectively,which were lower than(8.98±2.15)mg of the control group,wherein the 24 h oxycodone consumption of study group 2 was lower than that of study group 1,and the 24 h oxycodone consumption of study group 3 was lower than that of study group 2,the differences were statistically significant(P<0.05).At 6,12 and 24 h after the transversus abdominis plane block,the VAS scores of the control group were(5.43±1.06),(4.32±0.81),(3.22±0.79)points,respectively;the VAS scores of study group 1 were(4.67±1.02),(3.22±0.78),(2.54±0.77)points,respectively;the VAS scores of study group 2 were(3.54±0.78),(2.78±0.74),(2.03±0.69)points,respectively;and the VAS scores of study group 3 were(2.64±0.77),(2.15±0.68),(1.45±0.57)points respectively.At 6,12 and 24 h after the transversus abdominis plane block,the VAS scores of study group 3 were lower than those of study group 2,study group 1 and the control group.The VAS score of each group at 24 h after the transversus abdominis plane block was lower than their VAS scores at 6 and 12 h after the transversus abdominis plane block.The differences were statistically significant (P<0.05). The incidences of adverse reactions in study group 1 and study group 2 were slightly higher than that in the control group, but the difference was not statistically significant (P>0.05). The incidence of adverse reactions in study group 3 was higher than that in study group 2, and the difference was statistically significant (P<0.05). Conclusion With a reduction of oxycodone consumption, adding different doses of dexmedetomidine to ropivacaine in transversus abdominis plane block after laparoscopic oophorectomy maintains good postoperative analgesic effect, wherein 1 μg/kg dexmedetomidine is the optimal dose, which has prominent analgesic effect and higher safety.