右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜胆囊切除术患者的镇痛效果

摘要

目的 探讨右美托咪定复合罗哌卡因行腹横肌平面(TAP)阻滞对腹腔镜胆囊切除术(LC)患者围术期镇痛效果的影响.方法 选取2014年11月至2015年12月择期于全身麻醉(全麻)下行LC的患者60例,术后均使用静脉自控镇痛(PCIA).患者随机分为三组:未行TAP阻滞对照组(CON组)、右美托咪定复合罗哌卡因TAP阻滞组(DEX组)及单纯罗哌卡因阻滞组(TAP组).术中分别于入室后(T0)、切皮时(T1)、手术开始后30min(T2)、手术结束(T3)四个时间点记录患者平均动脉压(MAP)、收缩压(SBP)及心率(HR);统计手术时间、麻醉维持所用丙泊酚与舒芬太尼总量.术后记录2h、6h、12h、24h五个时间点患者Ramsay镇静评分、静息时与咳嗽时VAS评分,并记录患者PCIA首次按压时间(T),24h内有效按压次数(D1)、实际按压次数(D2)及PCIA装置内舒芬太尼用量(V).结果 与CON组比较,DEX组与TAP组患者术中丙泊酚与舒芬太尼的使用量明显降低,且DEX组降低更明显(P<0.05);除DEX组患者术中HR有所减慢外,各组患者血流动力学基本保持稳定.术后2h,DEX组患者Ramsay镇静评分高于其他两组(P<0.05),余时间点无明显差异;术后2h、6h、12h,DEX组与TAP组患者静息时与咳嗽时VAS评分均低于CON组(P<0.05);术后12h、24h,DEX组患者咳嗽时VAS评分低于TAP组(P<0.05).较TAP组,DEX组患者24h内PCIA有效按压次数(D1)、实际按压次数(D2)与舒芬太尼使用总量(V)均显著降低(P<0.05).结论 右美托咪定复合罗哌卡因可增强TAP阻滞在LC患者围术期的镇痛效果,并降低麻醉与镇痛药物的使用量.%Objective To investigate the perioperative analgesic effects of transverses abdominis plane(TAP)block with dexmedetomidine and ropivacaine on the patients underwent laparoscopic cholecystectomy(LC). Methods Sixty patients underwent LC in our hospital were recruited from November 2014 to December 2015,and the patient-controlled-intravenous-analgesia(PCIA)treatment were used for postoperative analgesia. Patients were randomized into three groups:DEX group was given TAP block by injection of dexmedetomidine and ropivacaine,and TAP group only received ropivacaine for TAP block while Con group did not receive TAP. The mean arterial pressure(MAP),systolic blood pressure(SBP)and heart rate (HR)after entering operation room(T0),incision of abdominal skin(T1),30min post-surgery(T2)and at the end of surgery were recorded respectively. The operation time,dosage of propofol and sufentanil during anesthesia maintenance were counted. Ramsay score and pain visual analog scale(VAS)at rest and during coughing were recorded in 2h,6h,12h and 24h after surgery. The first time of PCIA pressing(T),frequencies of effective pressing in 24h PCIA(D1),actual frequencies for PCIA pressing and dosage of sufentanil for PCIA were recorded. Results Compared with CON group,the usage of propofol and sufentanil during the surgery were significantly decreased in DEX group and TAP group,and it was more obvious in DEX group(P<0.05). The hemodynamic was stable in every group,except that the patients'heart rates were slightly slow in DEX group. Ramsay scores were higher in DEX group than in other groups two hours postsurgery and there was no difference at other time points;VAS scores were lower in DEX group and TAP group than in CON group either the patients were in rest or in cough 2 hours、6 hours and 12 hours postsurgery(P<0.05);VAS scores were lower in DEX group than in TAP group when patients coughed 12 hours and 24 hours postsurgery. The effective pressure numbers, actual pressure numbers of PCIA and the usage of sufentanil were all significantly decreased 24 houres postsurgery in DEX group than in TAP group (P<0.05). Conclusions Dexmedetomidine can increase the perioperative analgetic effect of TAP block in laparoscopic cholecystectomy and decrease the usage of the anesthetics and analgesic.