右美托咪定复合罗哌卡因在超声引导下腹直肌鞘阻滞联合腹横肌平面阻滞对腹腔镜手术患者术中镇痛的影响

Effects of the combination of dexmedetomidine and ropivacaine on intraoperative analgesia in ultrasound-guided rectus sheath block combined with transversus abdominis plane block on patients undergoing laparoscopic surgery

目的 探讨右美托咪定复合罗哌卡因在超声引导下腹直肌鞘阻滞(RSB)联合腹横肌平面阻滞(TAPB)对腹腔镜手术患者术中镇痛的影响。方法 选取2023年3—5月中国科学院合肥肿瘤医院收治的80例腹腔镜手术患者为研究对象,采用随机数字表法分为试验组和对照组,每组40例。试验组给予0.5μg/kg右美托咪定复合0.25%罗哌卡因在超声引导下RSB联合TAPB,对照组给予0.25%罗哌卡因在超声引导下RSB联合TAPB。比较分析两组患者的围手术期指标、术后不良反应发生情况。比较分析两组患者进入手术室后(T0)、切皮时(T1)、建立气腹后(T2)、拔管后(T3)的Ramsay评分、Prince-Henry评分、血流动力学水平[收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP)]。结果 试验组患者的瑞芬太尼用量和丙泊酚用量均少于对照组,差异均有统计学意义(P<0.05)。两组患者的术后不良反应发生情况比较差异无统计学意义(P>0.05)。与T0时刻比较,两组患者T1、T2、T3时刻的Ramsay评分均升高,Prince-Henry评分均降低,差异均有统计学意义(P<0.05);T1、T2、T3时刻,试验组患者的Ramsay评分均高于对照组,Prince-Henry评分均低于对照组,差异均有统计学意义(P<0.05)。与T0时刻比较,对照组患者T1、T2、T3时刻的SBP、DBP、HR、MAP均升高,差异均有统计学意义(P<0.05);T1、T2、T3时刻,试验组患者的SBP、DBP、HR、MAP均低于对照组,差异均有统计学意义(P<0.05)。结论 右美托咪定复合罗哌卡因在超声引导下RSB联合TAPB中对腹腔镜手术患者的镇静、镇痛效果显著,可维持患者的血流动力学水平稳定,且安全性较好。

Objective To explore the Effects of the combination of dexmedetomidine and ropivacaine on intraoperative analgesia in ultrasound-guided rectus sheath block(RSB)combined with transversus abdominis plane block(TAPB)on patients undergoing laparoscopic surgery.Method 80 laparoscopic surgery patients admitted to Hefei Cancer Hospital,Chinese Academy of Sciences from March to May 2023 were selected as the study objects.They were divided into experimental group and control group by random number table method,with 40 cases in each group.The experimental group was given 0.5µg/kg dexmedetomidine combined with 0.25%ropivacaine ultrasound-guided RSB combined with TAPB,and the control group was given 0.25%ropivacaine ultrasound-guided RSB combined with TAPB.The perioperative indexes and postoperative adverse reactions were compared between the two groups.Ramsay score,Prince-Henry score,the level of hemodynamics(SBP,DBP,HR,MAP)at entering the room(T0),cutting the skin(T1),establishing pneumoperitoneum(T2),after extubation(T3)were compared between the two groups.Result The dosage of remifentanil and propofol in experimental group were lower than those in control group,and the differences were significant(P<0.05).There was no significant difference in the occurrence of postoperative adverse reactions between the two groups(P>0.05).Compared with T0,Ramsay score at T1,T2 and T3 was increased,and Prince-Henry score was decreased in two groups,with significant differences(P<0.05).At T1,T2 and T3,Ramsay score in experimental group was higher than that in control group,and Prince-Henry score was lower than that in control group,with significant differences(P<0.05).Compared with T0,SBP,DBP,HR and MAP at T1,T2 and T3 were increased,and the differences were significant(P<0.05).At T1,T2 and T3,SBP,DBP,HR and MAP in experimental group were lower than those in control group,and the differences were significant(P<0.05).Conclusion Dexmedetomidine combined with ropivacaine in ultrasond-guided RSB combined with TAPB has significant sedative and analgesic effects on patients undergoing laparoscopic surgery,and can maintain the stable hemodynamic level of patients with good safety.