右美托咪定复合罗哌卡因腹横肌平面阻滞在腹膜透析置管术中的效果

目的探讨右美托咪定复合罗哌卡因行腹横肌平面(transversus abdominis plane,TAP)阻滞在腹膜透析置管术中的安全性和有效性。方法选择在TAP阻滞下行腹膜透析置管手术患者60例,男45例,女15例,年龄35~60岁,ASAⅡ或Ⅲ级,采用随机数字表法,将患者随机分为两组,每组30例:罗哌卡因(R组)和右美托咪定复合罗哌卡因组(DR组)。R组以0.375%罗哌卡因45 ml,DR组以右美托咪定1μg/kg+0.375%罗哌卡因复合液45 ml行腹横肌平面阻滞。记录入室后10 min(T1)、手术开始即刻(T2)、术中分离腹横肌(T3)、术毕(T4)时的MAP、HR、SpO2、Ramsay镇静评分。T1-T4时抽取静脉血样,测定血浆皮质醇(Cor)、血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。记录阻滞起效时间、持续时间、镇痛时间、患者满意度、术中舒芬太尼补救用量及围术期心动过缓、低血压、恶心等不良反应的发生情况。结果与R组比较,T2-T4时DR组MAP明显降低,HR明显减慢,Ramsay评分明显升高,血浆Cor、E、NE浓度明显降低(P<0.05),阻滞持续时间、镇痛时间明显延长(P<0.05),术中舒芬太尼用量明显减少(P<0.05),患者满意度明显升高(P<0.05)。两组阻滞起效时间、SpO2及心动过缓、低血压、恶心发生率差异无统计学意义。结论右美托咪定1μg/kg复合0.375%罗哌卡因行腹横肌平面阻滞用于腹膜透析置管术,可有效减轻应激反应,延长阻滞持续时间和镇痛时间,改善麻醉效果。

Effect of combination of dexmedetomidine and ropivacaine injection by transversus abdominis plane block for peritoneal dialysis catheter placement

Objective To investigate the safety and efficacy of dexmedetomidine mixed with ropivacaine for peritoneal dialysis catheter placement by transversus abdominis plane(TAP)block.Methods Sixty patients under peritoneal dialysis catheter placement,45 males and 15 females,aged 35-60 years,falling into ASA physical statusⅡorⅢ,were divided into two groups using a random number table,and 30 cases in each group:ropivacaine group(group R),ropivacaine+dexmedetomidine group(group DR).TAP block was performed,and 0.375%ropivacaine 45 ml was injected in group R,while the equal volume of 0.375%ropivacaine mixed with 1μg/kg dexmedetomidine was used in group DR.MAP,HR,SpO2 and Ramsay sedation score were recorded and venous blood samples were collected for determination of cortisol(Cor),epinephrine(E)and norepinephrine(NE)concentrations in plasma 10 min after entering operation room(T1),at the beginning of the operation(T2),pulling the transversus abdominis(T3)and at the end of the surgery(T4).Block onset time,blockade duration,duration of analgesia and the consumption of sufentanil during the operation were recorded.Patient’s satisfaction with analgesia was assessed and the occurrence of adverse reactions such as bradycardia,hypotension,nausea and vomiting was recorded during the perioperative period.Results Compared with group R,MAP,HR and the concentrations of the Cor,E,NE in plasma were significantly decreased,Ramsay sedation score was increased in group DR at T2-T4(P<0.05).Blockade duration and duration of analgesia were longer and the degree of patients’satisfaction with analgesia was higher in group DR compared with group R(P<0.05).No significant change was found in the block onset time,SpO2 and occurrence of adverse reactions between group R and group DR.Conclusion Dexmedetomidine 1μg/kg combined with 0.375%ropivacaine can reduce stress response effectively,prolong the duration of the block and analgesia,improve the analgesic efficacy of transversus abdominis plane block for peritoneal dialysis catheter placement.