罗哌卡因复合右美托咪定腹腔灌洗对腹腔镜下阑尾切除术的镇痛效果

Postoperative analgesic effect through intraperitoneal instilLAtion with ropivacaine and ropivacaine-dexmedetomidine after LAparoscopic appendectomy

目的探讨罗哌卡因复合右美托咪定腹腔灌洗在腹腔镜阑尾切除术(LA)的镇痛效果。方法选择浙江省湖州市第一人民医院2019年6月-2020年10月LA患者102例。采用随机数字表法分为对照组、罗哌卡因组和复合组(罗哌卡因复合右美托咪定)。对照组予生理盐水100mL,罗哌卡组予罗哌卡因2mg/kg+生理盐水至100mL,复合组给予罗哌卡因2mg/kg+右美托咪定1μg/kg+生理盐水至100mL。三组均使用无背景剂量PCIA(舒芬太尼100μg+生理盐水至100mL)。记录术后2、4、8、12、24、48小时静息和活动时VAS疼痛评分、手术时间、苏醒后生命体征、麻醉复苏室停留时间、舒芬太尼用量、首次按压PCIA泵时间、术后不良反应(恶心呕吐、肩痛等)发生情况。结果(1)疼痛评分。无论是静息时还是活动时,与对照组比较,术后罗哌卡因组和复合组2、8、12、24、48静息时VAS疼痛评分均明显降低(P<0.05)。罗哌卡因组与复合组比较,术后4小时静息时复合组VAS评分明显降低(P<0.05),其余各时间段两组间差异无统计学意义。(2)术中与术后情况。舒芬太尼用量罗哌卡因组与复合组明显少于对照组(P<0.05),复合组明显少于罗哌卡因组(P<0.05);首次按压PCIA泵时间罗哌卡因组与复合组明显长于对照组(P<0.05),复合组明显长于罗哌卡因组(P<0.05)。三组手术时间、苏醒后平均动脉压、心率及PACU停留时间差异均无统计学意义(P>0.05)。(3)不良反应。三组恶心呕吐及肩痛发生率均未见明显差异(P>0.05),罗哌卡因组和复合组均未出现罗哌卡因毒性反应。结论罗哌卡因复合右美托咪定腹腔灌洗为腹腔镜阑尾切除术后提供较好的镇痛效果,且安全性好。

Objective To investigate the analgesic effect of ropivacaine combined with dexmedetomidine intraperitoneal lavage in laparoscopic appendectomy(LA).Methods 102 patients with La in Huzhou first people's Hospital from June 2019 to October 2020 were selected.The patients were randomly divided into control group、ropivacaine group and composite group(ropivacaine combined with dexmedetomidine).control group was given 100mL normal saline,ropivacaine group was given 2mg/kg ropivacaine+normal saline to 100mL,and composite group was given 2mg/kg ropivacaine+dexmedetomidine 1μg/kg+normal saline to 100mL.PCIA without background dose(sufentanil 100μg+normal saline to 100mL).VAS pain score、operation time、vital signs after awakening、stay time in anesthesia and resuscitation room、sufentanil dosage、time of first pressing PCIA pump、occurrence of postoperative adverse reactions(nausea、vomiting、shoulder pain、etc.)were recorded at 2、4、8、12、24 and 48 hours after operation.Results(1)pain score.Compared with control group,the VAS pain scores of ropivacaine group and composite group at 2、8、12、24 and 48 rest were significantly lower(P<0.05).Compared with composite group,the VAS score of composite group decreased significantly at rest 4 hours after operation(P<0.05),and there was no significant difference between the two groups at other time periods.(2)Intraoperative and postoperative conditions.The dosage of sufentanil in ropivacaine group and composite group was significantly less than that in control group(P<0.05),and that in composite group was significantly less than that in ropivacaine group(P<0.05);The time of first pressing PCIA pump in ropivacaine group and composite group was significantly longer than that in control group(P<0.05),and that in composite group was significantly longer than that in ropivacaine group(P<0.05).There was no significant difference in operation time,mean arterial pressure、heart rate and PACU residence time among the three groups.(3)There was no significant difference in the incidence of nausea、vomiting and shoulder pain among the three groups(P>0.05).There were no patients with ropivacaine toxicity in ropivacaine group and composite group.Conclusion Ropivacaine combined with dexmedetomidine intraperitoneal lavage can provide better analgesic effect and safety after laparoscopic appendectomy.