右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中的应用

目的：研究右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用的有效性及安全性。方法选择择期行阴式子宫切除术患者40例（ASA Ⅰ～Ⅱ级），随机分成两组，选择硬腰联合麻醉下手术，麻醉平面固定后以超声引导给予患者双侧腹横肌膜神经阻滞，Ⅰ组患者选用0．5μg／kg 右旋美托咪啶＋0．2％罗哌卡因，每侧20 mL，Ⅱ组以相同方法给予同量生理盐水。记录麻醉前（T0）、麻醉平面确定后（T1）、手术开始（T2）、牵拉子宫（T3）、术毕（T4）患者的 HR、MAP、SpO2及 NTI 评分；评价并记录牵拉反应、术后认知功能障碍及谵妄的发生及患者舒适度及满意度。结果两组患者一般情况无显著性差异（P ＞0．05）；与 I 组相比，Ⅱ组 HR 在 T3时刻有显著性降低，差异有统计学意义（P ＜0．05），牵拉反应评价Ⅰ组评为优的患者个数明显多于Ⅱ组，差异有统计学意义（P ＜0．05）；Ⅰ组舒适度及满意度评定为优的患者个数明显多于Ⅱ组，差异有统计学意义（P ＜0．05）。结论右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用是安全有效的。

Effect of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy

Objective To observe the effectiveness and safety of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy. Methods Forty scheduled for vaginal hysterectomy (ASAⅠ ~Ⅱ)were randomly assigned to 2 groups.All patients received spinal anesthesia,and ultra-sound-guided subcostal transverses abdominis plane block then,Group Ⅰ:0.5 μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side,and saline was used for Group Ⅱ.HR、MAP SpO2 and NTI scale were recorded at the time points of pre-anesthesia (T0 ),confirmation of anesthesia plane (T1 ),beginning of surgery (T2 ),pulling uterus (T3 ),surgery end (T4 ). Effect of dragging reaction,POCD and delirious and degree of comfort and degree of satisfaction of patients were valuated. Re-sults The general condition did not differ between the two groups (P >0.05).Compared to Group Ⅰ,HR of Group Ⅱ at the time point of T3 was significant lower (P <0.05),number of patients with excellent dragging reaction of Group Ⅰ was signifi-cant higher (P <0.05)and patients of Group Ⅰ were more comfortable and satisfied than patinents of Group Ⅱ (P <0.05). Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropiva-caine is effective and safe for vaginal hysterectomy in elderly female.