CAJ | 학술논문

目的：观察腹腔镜下结肠根治术后右美托咪定超声引导下腹横肌平面(TAP)阻滞的镇痛效果，及其对早期恢复的影响。方法腹腔镜下结肠癌根治术患者40例均分为右美托咪定组(DEX组)和对照组(CON组)。手术结束后在超声引导下行TAP阻滞。DEX组予右美托咪定1μg/kg+0.25%罗哌卡因至20 ml，CON组予0.25%罗哌卡因20 ml。记录术后2 h、6 h、12 h、24 h、48 h静息状态、咳嗽时疼痛视觉模拟评分(VAS)和Ramsay评分，记录最高感觉阻滞平面、感觉阻滞维持时间、术后首次镇痛泵按压时间和术后第一天总按压次数和舒芬太尼用量，患者术后首次排气时间、进食时间和住院时间。结果术后2 h、6 h、12 h，DEX组VAS评分显著低于CON组(P<0.001)，Ramsay评分明显高于CON组(P<0.01)；DEX组较CON组感觉阻滞维持时间显著延长(P<0.001)，首次镇痛泵按压时间显著较晚(P<0.001)，镇痛泵按压次数显著减少(P<0.001)，舒芬太尼用量显著减少(P<0.001)；DEX组术后首次排气时间、进食时间和出院时间显著早于CON组(P<0.001)。结论右美托咪定能显著增强罗哌卡因的TAP阻滞效果，减轻术后疼痛，促进术后恢复。
목적：관찰복강경하결장근치술후우미탁미정초성인도하복횡기평면(TAP)조체적진통효과，급기대조기회복적영향。방법복강경하결장암근치술환자40례균분위우미탁미정조(DEX조)화대조조(CON조)。수술결속후재초성인도하행TAP조체。DEX조여우미탁미정1μg/kg+0.25%라고잡인지20 ml，CON조여0.25%라고잡인20 ml。기록술후2 h、6 h、12 h、24 h、48 h정식상태、해수시동통시각모의평분(VAS)화Ramsay평분，기록최고감각조체평면、감각조체유지시간、술후수차진통빙안압시간화술후제일천총안압차수화서분태니용량，환자술후수차배기시간、진식시간화주원시간。결과술후2 h、6 h、12 h，DEX조VAS평분현저저우CON조(P<0.001)，Ramsay평분명현고우CON조(P<0.01)；DEX조교CON조감각조체유지시간현저연장(P<0.001)，수차진통빙안압시간현저교만(P<0.001)，진통빙안압차수현저감소(P<0.001)，서분태니용량현저감소(P<0.001)；DEX조술후수차배기시간、진식시간화출원시간현저조우CON조(P<0.001)。결론우미탁미정능현저증강라고잡인적TAP조체효과，감경술후동통，촉진술후회복。
Objective To investigate the effect of ultrasound-guided subcostal transverses abdominis plane (TAP) block with dexmedeto-midine after laparoscopic radical operation. Methods 40 patients underwent laparoscopic radical operation for colorectal cancer were ran-domized into dexmedetomidine group (group DEX) and control group (group CON). All the patients received ultrasound-guided subcostal TAP block after operation, Group DEX with dexmedetomidine 1μg/kg and 0.25%ropivacaine to 20 ml, and group CON with 0.25%ropiva-caine 20 ml. All the patients were assessed with Ramsay scores and the pain at rest and on coughing were assessed with Visual Analogue Scale (VAS), 2, 6, 12, 24 and 24 hours after operation. The highest level and the duration of sensory blockade, the first time and the total times of pressing the analgesia pump in the first day after operation, and the requirements of sufentanil were recorded. First flatus time, first diet time and the length of hospital stay were compared. Results The scores of VAS were significantly less (P<0.001), and the Ramsay scores were more in the group DEX than in the group CON (P<0.01) 2, 6 and 12 hours after operation; with the longer time of sensory blockade (P<0.001), the later to first press the analgesia pump (P<0.001), the less frequence of pressing the analgesia pump (P<0.001), and less dosage of sufentanil (P<0.001). The first flatus time, first diet time were significantly earlier in the group DEX than in the group CON (P<0.001), with the less length of total hospital stay (P<0.001). Conclusion Dexmedetomidine can promote the anaesthesia of ultra-sound-guided subcostal TAP block with ropivacaine and improve the recovery after laparoscopic radical operation.