右美托咪定联合罗哌卡因应用在剖宫产全麻中的效果观察

Observation on the Effect of Dexmedetomidine Combined with Ropivacaine in General Anesthesia for Cesarean Section

目的:探讨腹横肌平面阻滞(TAPB)联合右美托咪定对全麻妇科患者的应用价值。方法:选取2021年9月—2023年10月在本院行全麻剖宫产产妇92例,按随机数字表法分为观察组(n=46)与对照组(n=46),对照组采用腹横肌平面阻滞联合罗哌卡因,观察组在对照组基础上加用右美托咪定。对比两组不同时间[麻醉前(T_0)、切皮时(T_(1))、切皮后5分钟(T_(2))、胎儿娩出(T_(3))、手术结束时(T_(4))]血流动力学[平均动脉压(MAP)、心率(HR)]、不同时间(术后2h、4h、8h、12h、24h)静息状态下、活动状态下疼痛评分[视觉模拟评分法(VAS)评分]、不同时间(术后2h、4h、8h、12h、24h)舒适度评分、不同时间(麻醉前、拔管后5min、拔管后12h)苏醒镇静程度、不同时刻(术后即刻、术后12h、术后24h)血清泌乳素水平、静脉自控镇痛泵使用状况(术后24h舒芬太尼使用量、24h内镇痛泵有效按压次数)及不良反应发生率。结果:观察组T_(1)、T_(2)、T_(3)时MAP、HR水平低于对照组,且波动幅度小于对照组(P<0.05);观察组术后8h、12h、24h静息状态下、活动状态下VAS评分低于对照组(P<0.05);观察组术后8h、12h、24h舒适度评分高于对照组(P<0.05);观察组拔管后5min苏醒镇静程度评分低于对照组(P<0.05);观察组术后12h、24h血清泌乳素水平高于对照组(P<0.05);观察组术后24h舒芬太尼使用量少于对照组,24h内镇痛泵有效按压次数低于对照组(P<0.05);观察组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论:TAPB联合右美托咪定在全麻妇科患者中可维持血流动力学稳定,缓解疼痛,提高患者舒适度,改善苏醒质量,促进初乳分泌,减少麻醉药物用量,降低镇痛泵有效按压次数,具有安全性。

Objective:To investigate the application value of transversus abdominis plane block(TAPB)combined with dexmedetomidine in gynecological patients undergoing general anesthesia.Methods:From September 2021 to October 2023,92 parturients undergoing cesarean section under general anesthesia in our hospital were selected and divided into observation group(n=46)and control group(n=46)according to the random number table method.The control group was treated with transversus abdominis plane block combined with ropivacaine,and the observation group was treated with dexmedetomidine on the basis of the control group.The hemodynamics[mean arterial pressure(MAP),heart rate(HR)]at different time[before anesthesia(T_0),skin incision(T_(1)),5 minutes after skin incision(T_(2)),fetal delivery(T_(3)),end of operation(T_(4))],different time(2h,4h,8h,12h,24h after operation)resting state,activity pain score[visual analogue scale(VAS)score],different time(2h,4h,8h,12h,24h after operation)comfort score,different time(before anesthesia,5 min after extubation,12h after extubation)recovery degree of sedation,different time(immediately after operation,12h after operation,24h after operation)serum prolactin level,the use of intravenous analgesia pump(24h after operation,sufentanil dosage,24h analgesic pump frequency and effective adverse reactions)were compared between the two groups.Results:The levels of MAP and HR at T_(1),T_(2) and T_(3) in the observation group were lower than those in the control group,and the fluctuation range was smaller than that in the control group(P<0.05).The VAS score of the observation group was lower than that of the control group at 8 h,12 h and 24 h after operation(P<0.05).The comfort score of the observation group at 8 h,12 h and 24 h after operation was higher than that of the control group(P<0.05).The sedation score of the observation group was lower than that of the control group at 5 min after extubation(P<0.05).The serum prolactin levels at 12 h and 24 h after operation in the observation group were higher than those in the control group(P<0.05).The amount of sufentanil used in the observation group was less than that in the control group at 24 h after operation,and the effective pressing times of the analgesic pump within 24 h were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P>0.05).Conclusion:TAPB combined with dexmedetomidine can maintain hemodynamic stability,relieve pain,improve patient comfort,improve the quality of awakening,promote colostrum secretion,reduce the amount of anesthetic drugs,and reduce the effective pressing times of analgesic pump in gynecological patients under general anesthesia,which is safe.