2020 年第 5 期 第 15 卷

不同剂量右美托咪定联合腹横肌平面阻滞对腹腔镜胆囊切除患者快速康复的影响

Effect of different doses of dexmedetomidine combined with transversus abdominis plane block on rapid recovery of patients undergoing laparoscopic cholecystectomy

作者：谭红保1;陈莉2;赵倩1;彭毅梅1;肖卫强1;黄志达1

英文作者：Tan Hongbao1 Chen Li2 Zhao Qian1 Peng Yimei1 Xiao Weiqiang1 Huang Zhida1

单位：1长沙市第四医院麻醉科410006；2湖南省脑科医院肾内科，长沙410007

英文单位：1Department of Anesthesiology the Fourth Hospital of Changsha Changsha 410006 China； 2Department of Nephrology Brain Hospital of Hunan Province Changsha 410007 China

关键词：右美托咪定；腹腔镜胆囊切除；快速康复

英文关键词：Dexmedetomidine;Laparoscopiccholecystectomy;Rapidrecovery

• 摘要：

• 目的 探讨右美托咪定联合腹横肌平面阻滞对腹腔镜胆囊切除术（LC）患者快速康复的影响。方法 选择2018年5月至2019年5月长沙市第四医院择期全身麻醉下行LC手术患者120例，采用随机数字表法，将所有患者分成4组，每组30例：对照组（C组，给予0.25%罗哌卡因40 ml）、低剂量右美托咪定组（L组，右美托咪定0.25 μg/kg复合0.25%罗哌卡因共40 ml）、中剂量右美托咪定组（M组，右美托咪定0.5 μg/kg复合0.25%罗哌卡因共40 ml）、高剂量右美托咪定组（H组，右美托咪定1 μg/kg复合0.25%罗哌卡因共40 ml）。记录各组麻醉时长、手术时长、术中输液量、出血量等；比较各组首次下床活动时间、肛门排气时间、住院时间；采用疼痛视觉模拟量表（VAS）评分法评估比较各组患者出手术室时及术后8、24、48 h静息疼痛程度。结果 4组患者麻醉时长、手术时长、补液量、出血量等差异均无统计学意义（均P＞0.05）。M组和H组首次下床活动时间、肛门排气时间、住院时间短于C组［分别为（5.7±0.9）、（5.2±0.9）h比（8.8±1.0）h，（7.8±1.7）、（6.5±1.9）h比（13.5±2.2）h，（5.0±0.4）、（4.9±0.3）d比（6.5±0.5）d］，差异均有统计学意义（均P＜0.05）；在手术室时及术后8、24、48 h时M组、H组静息VAS评分均明显低于C组，差异均有统计学意义（均P＜0.05）。结论右美托咪定联合腹横肌平面阻滞能够促进LC患者快速康复，可能机制是通过增强腹横肌平面阻滞镇痛效果。其促进LC患者快速康复作用的最低有效剂量是中等剂量（0.5 μg/kg）。

• Objective To investigate the effect of dexmedetomidine combined with transversus abdominis plane (TAP) block on the rapid recovery of laparoscopic cholecystectomy (LC) patients. Methods From May 2018 to May 2019, 120 patients with elective general anesthesia undergoing LC surgery in the Fourth Hospital of Changsha were selected. All patients were divided into 4 groups using random number table, with 30 patients in each group, including control group (group C, 0.25% ropivacaine), low dose dexmedetomidine group (group L, dexmedetomidine 0.25 μg/kg combined 0.25% ropivacaine), medium dose dexmedetomidine Group (group M, dexmedetomidine 0.5 μg/kg combined 0.25% ropivacaine) and high dose dexmedetomidine group (group H, dexmedetomidine 1 μg/kg combined 0.25% roperacain). The duration of anesthesia, duration of operation, intraoperative fluid volume and amount of bleeding were recorded. The first time of out of bed, the time of anus exhaust and the length of hospital stay were compared. The visual analog scale (VAS) was used to evaluate the degree of resting pain at 8, 24, 48 h after surgery. Results There were no significant differences in anesthesia duration, duration of surgery, fluid volume, and amount of bleeding in 4 groups (P>0.05). The first time of out of bed, the time of anal exhaust and the length of hospital stay in group M and group H were statistically shorter than those in group C ［(5.7±0.9), (5.2±0.9)h vs (8.8±1.0)h； (7.8±1.7), (6.5±1.9)h vs (13.5±2.2)h； (5.0±0.4), (4.9±0.3)d vs (6.5±0.5)d， all P＜0.05］; in the operating room, the resting VAS scores of group M and group H were significantly lower than those of the control group at 8 and 24, 48 h after operation (P＜0.05). ConclusionDexmedetomidine combined with transverse abdominis plane block can promote rapid recovery of LC patients by enhancing the analgesic effect of the transverse abdominis plane block. The baseline dose that promotes rapid recovery in LC patients is a moderate dose (0.5 μg/kg).