超声引导下局麻药复合右美托咪定腹横肌平面阻滞在妇科开腹手术患者中的应用效果

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摘要目的探讨超声引导下局麻药复合右美托咪定腹横肌平面阻滞（TAPB）在妇科开腹手术患者中的应用效果。方法选取2014年10月～2016年8月于广东省中医院行开腹子宫和卵巢囊肿切除术的患者90例作为研究对象，按随机数字表法将其分为三组：对照组（C组）、局麻药组（T组）和局麻药复合右美托咪定组（DT组），每组30例。三组患者均行常规气管插管全身麻醉，在此基础上，T组和DT组于麻醉诱导结束后行B超引导下双侧TAPB，其中T组和DT组分别注射0.4%罗哌卡因30 mL和0.4%罗哌卡因复合0.75 μg/kg右美托咪定30 mL。比较三组患者自主呼吸恢复时间、苏醒时间及拔管时间，记录术后视觉模拟评分（VAS）、镇静评分（Ramsay评分）以及不良反应发生情况，观察双侧阻滞侧温觉平面阻滞率。所得数据采用统计学软件SPSS 18.0分析处理。结果与C组比较，T组和DT组丙泊酚用量减少，自主呼吸恢复时间、苏醒时间和拔管时间缩短，术后8、12、24 h（T1～T3）时间点VAS评分降低（P ＜ 0.05）。与T组比较，DT组丙泊酚用量减少，自主呼吸恢复时间、苏醒时间和拔管时间缩短，T1～T3时VAS评分降低（P ＜ 0.05）。三组间Ramsay评分和不良反应发生率比较差异无统计学意义（P ＞ 0.05）。T组、DT组术后24 h时阻滞侧温觉平面阻滞率分别为76.7%、86.7%。结论 B超引导下局麻药复合右美托咪定TAPB在妇科开腹手术中的麻醉恢复快，术后镇痛效果较好，且精准和安全性高。

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	吴建魏彭菊香何强徐乐李向宇招伟贤

关键词 ：右美托咪定, 罗哌卡因, 超声, 腹横肌平面阻滞, 妇科开腹手术, 术后镇痛

Abstract：Objective To explore application effects of ultrasound-guided transversus abdominis plane blocks (TAPB) with local anesthetics and Dexmedetomidine in patients with gynecological laparotomy. Methods Ninety patients underwent hysterectomy and ovarian cyst resection in Guangdong Hospital of Traditional Chinese Medicine from October 2014 to August 2016 were selected as research objects, and they were randomly divided into three groups by random number table: control group (group C), local anesthetic medicine group (T group), local anesthetics and Dexmedetomidine group (DT group), with 30 cases in each group. Patients in three groups were treated with normal endotracheal intubation and general anesthetic. After induction of anesthesia, B ultrasound-guided bilateral TAPB were performed in T group and DT group. The patients in T group and DT group were respectively injected with 30 mL of 0.4% Ropivacaine and 30 mL of 0.4% Ropivacaine combined with 0.75 μg/kg Dexmedetomidine. The recovery time of spontaneous breathing, waking time and extubation time of the three groups were compared, and postoperative visual analogue scale (VAS), Ramsay score and the incidence of adverse reactions were recorded, and the rates of temperature plane block in bilateral block sides were observed. The data was analyzed by statistical software SPSS 18.0. Results Compared with group C, the amount of Propofol in T group and DT group was reduced, the recovery time of spontaneous breathing, waking time and extubation time were shortened, and the VAS scores after operation for 8, 12, 24 h (T1-T3) were reduced (P ＜ 0.05). While compared with T group, the amount of Propofol in DT group was reduced, the recovery time of spontaneous breathing, waking time and extubation time were shortened, and the VAS scores at T1-T3 were reduced (P ＜ 0.05). There were no significant differences of Ramsay scores and the incidence of adverse reactions among the three groups (P ＞ 0.05). The rate of temperature plane block in block sides of T group and DT group after operation for 24 h was 76.7%, 86.7% respectively. Conclusion Local anesthetics combined with Dexmedetomidine for B ultrasound-guided TAPB has faster recovery of anesthesia and better postoperative analgesia, with high accuracy and safety in gynecological laparotomy.

Key words： Dexmedetomidine Ropivacaine Ultrasound Transversus abdominis plane blocks Gynecological laparotomy Postoperative analgesia

基金资助:广东省中医药局项目（20152146）。

作者简介: 吴建魏（1977-），男，硕士；研究方向：脏器保护与超声引导下的神经阻滞。

引用本文:

吴建魏彭菊香何强徐乐李向宇招伟贤. 超声引导下局麻药复合右美托咪定腹横肌平面阻滞在妇科开腹手术患者中的应用效果[J]. 中国医药导报, 2017, 14(34): 62-65.
WU Jianwei PENG Juxiang HE Qiang XU Le LI Xiangyu ZHAO Weixian. Application effects of ultrasound-guided transversus abdominis plane blocks with local anesthetics and Dexmedetomidine in patients with gynecological laparotomy. 中国医药导报, 2017, 14(34): 62-65.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I34/62

[1] 薛玉荣，陈永权.妇科腹腔镜手术病人右美托咪定混合罗哌卡因腹横肌平面阻滞联合全麻的效果[J].中华麻醉学杂志，2015，35（9）：1114-1117.
[2] Rafi AN. Abdominal field block：a new approach via the lumbar triangle [J]. Anaesthesia，2001，56（10）：1024-1026.
[3] McDermott G，Korba E，Mata U，et al. Should we stop doing blind transversus abdominis plane blocks [J]. Br J Anaesth，2012，108（3）：499-502.
[4] Nie Y，Liu Y，Luo Q，et al. Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia：a randomised，placebo-controlled study [J]. Eur J Anaesthesiol，2014，31（4）：197-203.
[5] Brummctt CM，Hong EK，Janda AM，et al. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current [J]. Anesthesiology，2011，115（4）：836-843.
[6] Marhofer D，Kettner SC，Marhofer P，et al. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block：a volunteer study [J]. Br J Anaesth，2013，110（3）：438-442.
[7] 田雪，安海燕，冯艺.超声引导下腹横肌平面阻碍滞用于腹股沟疝成形术病人术后镇痛的效果[J].中华麻醉学杂志，2013，33（3）：275-278.
[8] Lin YN，Li Q，Yang RM，et al. Addition of dexmedetomidine to ropivaeaine improves cervical plexus block [J]. Aeta Anaesthesiol Taiwan，2013，51（2）：63-66.
[9] 李金玉，葛东建，祁宾，等.不同剂量右美托咪定混合罗哌卡因用于臂丛神经阻滞的效果[J].中华麻醉学杂志，2013，33（6）：711-713.
[10] Brummett CM，Amodeo FS，Janda AM，et al. Perineural dexme.detomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block [J]. Reg Anesth Pain Med，2010，35（5）：427-431.
[11] 张龙新，周敏，陈小琳.超声引导下腹横肌平面阻滞在全子宫切除术+盆腔淋巴结清扫术后镇痛的应用[J].福建医药杂志，2013，12（5）：115-116.
[12] 王琳，徐铭军.超声引导腹横肌平面阻滞对妇科腹腔镜手术后镇痛的影响[J].临床麻醉学杂志，2013，18（11）：1057-1058.
[13] 杨世娟，郑贵永，蒙建栋.超声引导腹横机平面阻滞在妇科手术术后镇痛中的应用[J].吉林医学，2017，38（1）：109-111.
[14] 郑珈琳，罗世忠，钟庆.不同剂量罗哌卡因腹横肌平面阻滞在剖宫产术后镇痛中的疗效比较[J].西部医学，2013， 15（12）：1788-1790.
[15] 刘春贵，全守波，黎旭乾.超声引导下股神经阻滞在膝关节手术术后镇痛中的应用[J].包头医学院学报，2015， 11（4）：43-45.
[16] 单海华，王文娟，谢红.超声引导连续股神经阻滞在全膝关节置换术后镇痛中的应用[J].江苏医药，2011，24（18）：2145-2147.
[17] 董盛龙，朱少飞，林赛娟，等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志，2017，37（2）：259-262.
[18] 叶太财，周良军，卫才权，等.腹横肌平面阻滞联合地佐辛对妇科手术患者术后镇痛效果的影响[J].现代医院，2017，17（3）：421-424.
[19] 贺淑君，王雷，李玲，等.超声引导下腹横肌平面阻滞在剖宫产术后镇痛中的应用[J].中国医师进修杂志，2015， 38（10）：751-754.
[20] 王玉群.超声引导下腹横肌平面阻滞用于剖宫产术后镇痛[J].中国实用医药，2013，8（20）：106-107.