中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (6): 507-512.doi: 10.12007/j.issn.0258‐4646.2018.06.007

• 论著 • 上一篇    下一篇

超声引导腹横肌平面阻滞复合右美托咪定在老年患者腹股沟疝修补术术中及术后的镇痛效果

肖甄男, 商丽华, 龙波   

  1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004
  • 收稿日期:2018-03-21 出版日期:2018-06-30 发布日期:2018-05-29
  • 通讯作者: 龙波 E-mail:longbo_27@163.com
  • 作者简介:肖甄男(1988-),男,医师,硕士.
  • 基金资助:
    辽宁省社会发展攻关计划(2012225021)

Efficacy of a Combination of Dexmedetomidine with Ropivacaine for Ultrasound-guided Transversus Abdominis Plane Block in Elderly Patients Undergoing Inguinal Hernia Repair

XIAO Zhennan, SHANG Lihua, LONG Bo   

  1. Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2018-03-21 Online:2018-06-30 Published:2018-05-29

摘要: 目的 观察超声引导腹横肌平面阻滞(TAPB)复合右美托咪定(DEX)用于老年患者腹股沟斜疝修补术麻醉的安全性、有效性及镇痛效果。方法 选择拟行单侧腹股沟斜疝修补术的75岁以上男性患者40例,按照随机数字表法分为2组,T组在TAPB (1%罗哌卡因10 mL+DEX 20 μg+生理盐水10 mL)前15 min开始静脉泵注Dex 0.5 μg/kg,随后以0.4 μg·kg-1·h-1持续静脉泵注,直至手术结束前15 min停止;C组行腰硬联合麻醉并控制平面在T10。2组均监测术中生命体征,比较2组在入室(T0)、阻滞后15 min (T1)、切皮(T2)、结扎疝囊(T3)及手术结束(T4)时的平均动脉压、心率和脉搏血氧饱和度,记录2组术后2、4、8、12、24和48 h的疼痛评分、镇静评分和运动评分,以及术后额外使用镇痛药次数、尿潴留、恶心呕吐等不良反应的发生率。结果 T组麻醉效果满意18例,阻滞不全2例,C组腰硬联合阻滞成功17例,2例腰麻针未能置入蛛网膜下腔,1例置入腰麻针时有异感而放弃给药。与C组及术前相比,T组的心率偏慢(P<0.05),但仍在安全范围内。2组术后4、8、12、24 h的疼痛评分及术后镇痛药使用次数有统计学差异(P<0.05),2和4 h的运动评分有统计学差异(P<0.05)。T组不良反应发生率较低(P<0.05)。结论 DEX辅助TAPB操作简单可行,麻醉效果满意,术后镇痛效果较好,可作为老年患者腹股沟斜疝修补术的一种新的麻醉方式。

关键词: 右美托咪定, 罗哌卡因, 超声引导腹横肌平面阻滞, 腹股沟疝修补术

Abstract: Objective To investigate the efficacy of a combination of dexmedetomidine (DEX) with ropivacaine for ultrasound-guided transversus abdominis plane block (TAPB) in elderly patients undergoing inguinal hernia repair. Methods Forty male patients (age ≥ 75 years) were randomly assigned to the TAPB group (group T, n=20) or the control group (group C, n=20). In group T, 0.5 μg/kg of DEX was infused intravenously before TAPB. TAPB was performed with a solution of 10 mL of 1% ropivacaine, 20 μg DEX, and 10 mL of normal saline, and infused at 0.4 μg·kg-1·h-1 until 15 minutes before completion of the surgery. In group C, patients received combined spinal-epidural anesthesia (CSEA) for a sensory level of T10. The heart rate, mean blood pressure and oxygen saturation (SpO2) were recorded at T0 (baseline), T1 (15 minutes after TAPB), T2 (suturing of skin), T3 (ligation of hernial sac), and T4 (completion of surgery). The Prince-Henry score, Ramsay score, and Bromage score were recorded at 2, 4, 8, 12, 24, and 48 h. Supplemental use of analgesics and adverse events were also recorded. Results Eighteen patients in group T and 17 patients in group C underwent successful block. In group C, the needle failed to enter the subarachnoid space in two patients while one patient complained of paresthesia. In group T, the heart rate, Prince-Henry score at 4, 8, 12, and 24 h, and Bromage score at 2 and 4 h, were lower than that of group C. The use of supplemental analgesics and incidence of adverse events were also lower in group T. Conclusion A combination of DEX with ropivacaine for ultrasound-guided TAPB provides satisfactory anesthetic effect for elderly patients undergoing inguinal hernia repair.

Key words: dexmedetomidine, ropivacaine, ultrasound-guided transversus abdominis plane block, inguinal hernia repair

中图分类号: 

  • R614.4
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