右美托咪定并低浓度罗哌卡因在腹腔镜结直肠癌根治术腹横肌平面阻滞术后镇痛的应用

摘要

Objective To discuss the effect of dexmedetomidine mixed with low concentration of ropivacaine in application of transversus abdominis plane block of laparoscopic colorectal cancer radical surgery. Methods 96 cases of patients with anesthesia laparoscopic colorectal cancer radical surgery hospitalized from April 2013 to July 2015 in our hospital who were selected as the study objects,and they were given the transversus abdominis plane block analgesia project .They were divided into groups by random number table method,32 cases of patients of group A were used with 0.19% ropivacaine + saline; 32 cases of patients of group B were used with 0.19% ropivacaine + dexmedetomidine,and 32 cases of patients of group C were used with 0.25% ropivacaine +normal saline. They were sufentanil vein self-control analgesia(PCIA). The analgesic effect at different time after operation,24h sufentanil dose(V),first press analgesia pump time(T),PCA pressing times(D1)of patients of three groups were observed, and the safety of anesthesia and analgesia satisfaction were understood. Results VAS scores of group A at T2,T3,T4 were higher than those of group B and group C(P<0.05),and there were no significant differences among three groups at the T5 time(P>0.05); There were statistical differences in sufentanil dose(V),the first pressing time of analgesia pump(T),PCA(D1),effective pressing numbers PCA the number of attempts (D2)and other indicators of group A compared with those of groupB and group(P<0.05);There were no significant differences in the incidences of adverse reaction among three groups. The analgesic satisfaction rates of group B and group C were significantly higher than those of group A,the differences were significant(P<0.05). Conclusion Laparoscopic colorectal cancer radical surgery transversus abdominis plane block is applied dexmedetomidine which can improve analgesic effect of low concentration ropivacaine,which can achieve the same effect with 0.25% ropivacaine. It can reduce the risk of anesthesia,and it is worth promoting.%目的：探讨右美托咪定混合低浓度罗哌卡因应用于腹腔镜结肠癌根治术腹横肌平面阻滞的效果。方法选取2013年4月至2015年7月行择期全身麻醉（全麻）下腹腔镜结直肠癌根治术患者96例为观察对象，术后采用腹横肌平面阻滞镇痛方案，以随机数字表法分组，A组32例使用0.19%罗哌卡因+生理盐水；B组32例使用0.19%罗哌卡因+右美托咪定，C组32例使用0.25%罗哌卡因+生理盐水。均给予舒芬太尼静脉自控镇痛（PCIA）。对三组患者在术后不同时间的镇痛效果、24h舒芬太尼使用剂量（V）、首次按压镇痛泵时间（T）、PCIA有效按压次数（D1）、PCIA实际按压次数（D2）等进行观察，并了解麻醉安全性及镇痛满意度。结果 A组在T2、T3、T4时间段VAS评分明显较B组与C组高（P<0.05），T5时间段三组差异无统计学意义（P>0.05）；A组24h舒芬太尼使用剂量（V）、首次按压镇痛泵时间（T）、PCA有效按压次数（D1）、PCA实际按压次数（D2）等指标与B组、C组比较差异有统计学意义（P<0.05）；三组患者不良反应发生率无明显差异，B组与C组镇痛满意率明显高于A组，差异显著（P<0.05）。结论腹腔镜结直肠癌根治术腹横肌平面阻滞中应用右美托咪定能加强低浓度罗哌卡因镇痛作用，取得与0.25%罗哌卡因相同效果，可减少麻醉风险，值得推广。