上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (5): 526-.doi: 10.3969/j.issn.1674-8115.2019.05.016

• 论著·临床研究 • 上一篇    下一篇

右美托咪定复合罗哌卡因对于腹横筋膜阻滞时效的影响

封洲，王坚伟，张虓宇，徐子锋   

  1. 上海交通大学医学院附属国际和平妇幼保健院麻醉科，上海 200030
  • 出版日期:2019-05-28 发布日期:2019-07-26
  • 通讯作者: 王坚伟，电子信箱：wangjianwei_0219@163.com。
  • 作者简介:封洲（1988—），男，住院医师，硕士；电子信箱： fengzhou525@qq.com。
  • 基金资助:
    上海市卫生和计划生育委员会科研课题青年项目（ 20164Y0263）

Effect of ropivacaine combined with dexmedetomidine on onset and duration of transverse abdominis plane block

FENG Zhou, WANG Jian-wei, ZHANG Xiao-yu, XU Zi-feng   

  1. Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2019-05-28 Published:2019-07-26
  • Supported by:
    Youth Project of Scientific Research Subject of Shanghai Health and Family Planning Commission, 20164Y0263

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摘要： 目的 ·评估右美托咪定复合罗哌卡因对于超声引导下的腹横筋膜阻滞时效及术后镇痛效果的影响。方法 ·选取 180例美国麻醉医师协会（ American Society of Anesthesiologist，ASA）分级 Ⅰ～Ⅱ级，拟择期接受腹腔镜下卵巢囊肿剥除术的患者。患者手术结束，送至苏醒室 10 min后于超声引导下行双侧腹横筋膜阻滞，同时给予吗啡静脉自控镇痛泵用于术后镇痛。采用随机数字表法将患者随机分为 2组，即右美托咪定组（ Dex组）和对照组（ Con组），每组 90例。Dex组患者使用 40 mL含 100 μg右美托咪定的 0.375%罗哌卡因行腹横筋膜阻滞， Con组仅使用 40 mL 0.375%罗哌卡因。观察指标为腹部感觉神经阻滞的起效时间、持续时间，术后第 1次按压吗啡自控镇痛泵的时间、术后 48 h吗啡使用总量，以及腹横筋膜阻滞后 2 h内的平均动脉压和心率。结果 · Dex组患者的阻滞起效时间显著短于 Con组（P0.032），作用持续时间则比 Con组显著延长（ P0.012）；Dex组术后第 1次按压吗啡自控镇痛泵的时间也显著迟于 Con组（P0.008），术后 48 h吗啡使用总量明显减少（ P0.001）。Dex组患者的心率和平均动脉压均低于 Con组。结论 ·右美托咪定复合罗哌卡因可安全有效地应用于腹横筋膜阻滞；与单独应用罗哌卡因比较，复合用药起效更快，维持感觉阻滞时间更久，且可明显减少术后阿片类药物的用量。

关键词: 右美托咪定, 罗哌卡因, 复合用药, 腹横筋膜阻滞, 吗啡

Abstract:

Objective · To evaluate the effect of ropivacaine combined with dexmedetomidine on transverse abdominis plane (TAP) block guidedultrasound and postoperative analgesia. Methods · A total of 180 patients (ASA grade Ⅰ-Ⅱ ) undergoing laparoscopic ovarian cystectomy were randomly divided into control group (Con group) and dexmedetomidine group (Dex group). At the end of the operations, the patients were sent to the recovery rooms. After 10 minutes, TAP block was performed under the guidance of ultrasound, and morphine intravenous self-controlled analgesia pump was given for postoperative analgesia. The patients in Con group received TAP block with 40 mL of 0.375％ ropivacaine. The patients in Dex group received 40 mL of 0.375% ropivacaine containing 100 μg dexmedetomidine. The onset time, duration of the sensory nerve block, delay of the first press of morphine pump, and total amount of morphine within 48 h after the operation and hemodynamic parameters were recorded. Results · The onset time in Dex group was earlier than that in Con group (P0.032), and the duration of analgesia effect was also longer (P0.012). The delay of first morphine pump press was also significantly later than that in Con group (P0.008), and total morphine consumption significantly reduced within 48 h after operation (P0.001). In terms of heart rate and mean arterial pressure, they were all lower in Dex group than those in Con group. Conclusion · Ropivacaine combined with dexmedetomidine can be safely and effectively used in TAP block. Compared with ropivacaine alone, the combination can maintain a longer sensory block, which can significantly reduce postoperative opioid usage.

Key words: dexmedetomidine, ropivacaine, combined medication, transverse abdominis plane block, morphine

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