右美托咪定复合罗哌卡因双肋缘下腹横肌平面阻滞对开腹肝切术的镇痛观察

Analgesic observation of dexmedetomidine combined with ropivacaine bilateral subcostal TAP block for open hepatectomy

目的探索右美托咪定(DEX)复合罗哌卡因(ROP)双肋缘下腹横肌平面(TAP)阻滞对开腹肝切术的镇痛效果。方法选取2021年1月—2022年12月收治的100例开腹肝切术患者作为研究对象,随机分为ROP组(n=50)和ROP+DEX组(n=50)。所有患者均给予气管插管,借助超声引导行双肋缘下TAP阻滞;ROP组给予0.375%浓度的罗哌卡因40 mL进行麻醉,ROP+DEX组给予罗哌卡因联合右美托咪定(1μg/kg)进行麻醉。肝切术完成后,于缝合伤口前给予经静脉病人自控(PCIA)镇痛。观察并比较两组术后心率及平均动脉压等血流动力学指标、镇痛效果及不良反应发生情况。结果ROP+DEX组术后30、60、120 min时的心率、平均动脉压均低于ROP组(P<0.05);ROP+DEX组术后首次主诉疼痛时间显著晚于ROP组(P<0.01);ROP+DEX组术后2、6 h时视觉模拟评分(VAS)均明显低于ROP组(P<0.01);两组术后24 h内总体不良反应发生率比较差异无统计学意义(P>0.05)。结论罗哌卡因联合右美托咪定双肋缘下TAP阻滞开腹肝切术的术后镇痛效果明显,可显著延长镇痛时间,减轻疼痛,稳定循环,以提早实现患者下床活动的目标。

Objective To explore the analgesic effect of dexmedetomidine(DEX)combined with ropivacaine(ROP)bilateral subcostal transversal plane(TAP)block on open hepatectomy.Methods A total of 100 patients with open hepatectomy admitted to our hospital from January 2021 to December 2022 were selected as study subjects and randomly divided into ROP group(n=50)and ROP+DEX group(n=50).All patients received endotracheal intubation,followed by a bilateral subcostal block with ultrasound guidance.The ROP group was given 0.375%ropivacaine 40 mL.The ROP+DEX group was given ropivacaine combined with dexmedetomidine(1 g/kg).Afer hepatic resection was completed,intravenous patient controlled analgesia(PCIA)was given before wound suture.Hemodynamics parameters such as heart rate and mean arterial pressure,analgesic effect,and adverse reactions were observed and compared between the two groups.Results The heart rate and mean arterial pressure in the ROP+DEX group were significantly lower than those in the ROP group at 30,60 and 120 min after surgery(P<0.05).The first complaint of pain in the ROP+DEX group was later than that in the ROP group(P<0.01).The VAS scores of the ROP+DEX group were significantly lower than those of the ROP group at 2 and 6 h after surgery(P<0.01).There was no significant difference in the overall incidence of adverse reactions between the two groups within 24 h after surgery(P>0.05).Conclusion ROP combined with OEX TAP block for open liver resection under both costal margins has obvious analgesic effect,which can significantly prolong the analgesic time and reduce the degree of pain,stabilize circulation parameters,and realize patients'ambulation out of bed earlier,with high safety.