CAJ | 학술논문

目的评价妇科腹腔镜手术病人右美托咪定混合罗哌卡因用于腹横肌平面阻滞联合全麻的效果.方法择期腹腔镜卵巢囊肿切除术病人90例,年龄20～ 50岁,BMI 18～24 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为3组(n=30):全麻组(G组)、全麻+罗哌卡因用于腹横肌平面阻滞组(G+R组)和全麻+右美托咪定混合罗哌卡因用于腹横肌平面阻滞组(G+DR组).G+R组和G+DR组于麻醉诱导结束后于超声引导下行左侧腹横肌平面阻滞,G+R组和G+DR组分别注射0.375％罗哌卡因20 ml和0.375％罗哌卡因混合右美托咪定1μg/kg 20 ml.3组全麻诱导置入喉罩后行机械通气,麻醉维持:静脉输注瑞芬太尼0.2 μg· kg-1·min-1和异丙酚4～8 mg· kg-1·h-1,维持Narcotrend指数值37～ 46.术后仅G组进行静脉镇痛.记录腹横肌平面阻滞有关不良事件发生情况.记录苏醒时间、自主呼吸恢复时间、拔除喉罩时间及拔除喉罩后5 min时Steward评分.记录术后恶心呕吐及呼吸抑制的发生情况.结果与G组和G+R组比较,G+DR组苏醒时间、自主呼吸恢复时间和拔除喉罩时间缩短(P＜0.05或0.01),Steward评分差异无统计学意义(P＞0.05);G组和G+R组间上述指标比较差异无统计学意义(P＞0.05).与G组比较,G+R组和G+DR组术后恶心呕吐发生率降低(P＜0.05).3组术后均可维持VAS评分≤3分;G+R组和G+DR组未见腹横肌平面阻滞有关不良事件发生.结论妇科腹腔镜手术病人右美托咪定混合罗哌卡因用于腹横肌平面阻滞联合全麻的麻醉恢复快,还可避免术后痛觉过敏.
목적 평개부과복강경수술병인우미탁미정혼합라고잡인용우복횡기평면조체연합전마적효과.방법 택기복강경란소낭종절제술병인90례,년령20～ 50세,BMI 18～24 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법분위3조(n=30):전마조(G조)、전마+라고잡인용우복횡기평면조체조(G+R조)화전마+우미탁미정혼합라고잡인용우복횡기평면조체조(G+DR조).G+R조화G+DR조우마취유도결속후우초성인도하행좌측복횡기평면조체,G+R조화G+DR조분별주사0.375％라고잡인20 ml화0.375％라고잡인혼합우미탁미정1μg/kg 20 ml.3조전마유도치입후조후행궤계통기,마취유지:정맥수주서분태니0.2 μg· kg-1·min-1화이병분4～8 mg· kg-1·h-1,유지Narcotrend지수치37～ 46.술후부G조진행정맥진통.기록복횡기평면조체유관불량사건발생정황.기록소성시간、자주호흡회복시간、발제후조시간급발제후조후5 min시Steward평분.기록술후악심구토급호흡억제적발생정황.결과 여G조화G+R조비교,G+DR조소성시간、자주호흡회복시간화발제후조시간축단(P＜0.05혹0.01),Steward평분차이무통계학의의(P＞0.05);G조화G+R조간상술지표비교차이무통계학의의(P＞0.05).여G조비교,G+R조화G+DR조술후악심구토발생솔강저(P＜0.05).3조술후균가유지VAS평분≤3분;G+R조화G+DR조미견복횡기평면조체유관불량사건발생.결론 부과복강경수술병인우미탁미정혼합라고잡인용우복횡기평면조체연합전마적마취회복쾌,환가피면술후통각과민.
Objective To evaluate the efficacy of dexmedetomidine mixed with ropivacaine for transversus abdominis plane (TAP) block combined with general anesthesia in the patients undergoing gynecological laparoscopy.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 20-50 yr, with body mass index of 18-24 kg/m2, scheduled for elective gynecological laparoscopic ovarian cyst resection under general anesthesia, were randomly divided into 3 groups (n =30 each) using a random number table: general anesthesia group (group G) , general anesthesia + ropivacaine for TAP block group (group G+R), and general anesthesia + dexanedetomidine mixed with ropivacaine for TAP block group (group G+DR).After the end of anesthesia induction, ultrasound-guided left-sided unilateral TAP block was performed in G+R and G+DR groups.In G+R and G+DR groups, 20 ml of 0.375％ ropivacaine and 20 ml of 0.375％ ropivacaine mixed with 1 μg/kg dexmedetomidine were injected, respectively.After induction of general anesthesia, the laryngeal mask airway (LMA) was inserted, and the patients were mechanically ventilated in the 3 groups.Anesthesia was maintenaned with iv infusion of remifentanil 0.2 μg · kg-1 · min-1 and propofol 4-8 mg · kg-1 · h-1.Narcotrend index was maintained at 37-46.Only group G received postoperative intravenous analgesia.The occurrence of TAP block-related adverse events was recorded.The emergence time, time for recovery of spontaneous breathing, time for removal of LMA, and Steward score at 5 min after removal of LMA were recorded.The occurrence of postoperative nausea and vomiting, and respiratory depression was recorded.Results Compared with G and G+R groups,the emergence time, time for recovery of spontaneous breathing, and time for removal of LMA were significantly shortened (P＜0.05 or 0.01) , and no significant change was found in Steward score in group G+DR (P＞0.05).There was no significant difference in the above parameters between group G and group G+R (P＞0.05).Compared with group G, the incidence of postoperative nausea and vomiting was significantly decreased in G+R and G+DR groups (P＜0.05).VAS score was maintained ≤ 3 after operation in the 3 groups.No TAP block-related adverse events were found in G+R and G+DR groups.Conclusion Dexmedetomidine mixed with ropivacaine provides faster recovery from anesthesia, and avoids postoperative hyperalgesia when used for TAP block combined with general anesthesia in the patients undergoing gynecological laparoscopy.