不同剂量右美托咪定联合腹横肌平面阻滞对腹腔镜胆囊切除术患者血流动力学的影响

Effect of Different Doses of Dexmedetomidine Combined with Transverse Abdominal Muscle Plane Block on Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy

目的分析右美托咪定剂量选择对腹腔镜胆囊切除术患者的影响,为麻醉管理提供参考。方法随机选取2021年6月一2022年5月建湖县人民医院收治的90例腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)患者,采用随机数表法进行分组,将患者分为A、B、C组,每组30例。3组患者均采取全麻复合腹横肌阻滞,麻醉方案的差异主要在于各组使用的右美托咪定剂量不同,A组剂量为0.3μg/kg,B组剂量为0.5μg/kg,C组剂量为0.7μg/kg。对比3组患者的麻醉效果。结果T4、T5时间点,C组患者的收缩压(systolic pressure,SBP)水平明显低于A组、B组,差异有统计学意义(P<0.05)。T3、T4、T5时间点,C组患者的舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)水平明显低于A组、B组,差异有统计学意义(P<0.05)。各时间段,A组的视觉模拟评分法(Visual Analog Scoring,VAS)评分T0(2.17±0.53)分、T1(1.85±0.48)分、T2(1.72±0.43)分、T3(1.68±0.33分)高于B组与C组,差异有统计学意义(T0:t_(A组vsB组)=4.717、t_(A组vsC组)=5.950,T1:t_(A组vsB组)=3.037、t_(A组vsC组)=4.165,T2:t_(A组vsB组)=3.186、t_(A组vsC组)=4.149,T3:t_(A组vsB组)=5.323、t_(A组vsC组)=6.608,P<0.05)。结论右美托咪定的剂量对患者的血流动力学指标有影响,综合考虑SBP、DBP、HR等指标的稳定性与患者的术后疼痛状况,本药最低有效剂量为0.5μg/kg。

Objective To analysis the effect of dose selection of dexmedetomidine on patients undergoing laparoscopic cholecystectomy,and to provide reference for anesthesia management.Methods A total of ninety Laparoscopic cholecystectomy(LC) patients treated in Jianhu County People's Hospital from June 2021 to May 2022 were randomly selected for grouping by random number table method,and patients were divided into three groups of A,B and C,with thirty cases in each group.All patients in the three groups underwent general anesthesia combined with transitory abdominalis block,and the difference in anesthesia regimen was mainly due to the different doses of dexmedetomidine used in each group,which were 0.3 μg/kg in group A,0.5 μg/kg in group B,and 0.7 μg/kg in group C.The anesthesia effect of the three groups was compared.Results At T4 and T5 time points,the systolic pressure(SBP) level in group C was significantly lower than that in group A and group B,and the difference was statistically significant(P<0.05).At T3,T4 and T5 time points,diastolic blood pressure(DBP) and heart rate(HR) levels in group C were significantly lower than those in group A and group B,and the difference was statistically significant(P<0.05).The Visual Analog Scoring(VAS) scores of group A [T0(2.17±0.53) points,T1(1.85±0.48) points,T2(1.72±0.43) points,T3(1.68±0.33)points] were higher than those of group B and group C,and the difference was statistically significant(T0:t_(A group vs Bgroup)=4.717,t_(A group vs C group)=5.950;T1:t_(A group vs B group)=3.037,t_(A group vs C group)=4.165;T2:t_(A group vs B group)=3.186,t_(A group vs C group)=4.149;T3:t_(A group vs B group)=5.323,t_(A group vs C group)=6.608,P<0.05).Conclusion The dose of dexmedetomidine has an effect on the hemodynamic indexes of patients.Considering the stability of SBP,DBP,HR and other indexes as well as the postoperative pain status of patients,the lowest effective dose of dexmedetomidine is 0.5 μg/kg.