| 摘要: |
| ［摘要］ 目的 探讨右美托咪定联合罗哌卡因四点神经阻滞在腹腔镜肝肿瘤手术中的应用效果。方法 选取2021年8月至2022年7月于广西壮族自治区人民医院择期行全身麻醉下腹腔镜肝肿瘤手术的84例患者，随机分为右美托咪定复合罗哌卡因组（A组）30例，罗哌卡因组（B组）30例，对照组（C组）24例。A组、B组在超声引导下行右侧低位前锯肌平面、右侧肋缘下腹横肌平面及双侧腹直肌后鞘共四点神经阻滞，C组不予神经阻滞。比较三组术中麻醉时（T1）、切皮前5 min（T2）、切皮后5 min（T3）、肝切除时（T4）、缝皮时（T5）的血流动力学变化，术后48 h内（2 h、6 h、12 h、24 h、48 h）的静息状态及运动状态视觉模拟量表（VAS）评分，术后48 h内镇痛泵按压次数以及不良反应发生情况。结果 在T1～T5时间点，三组平均动脉压（MAP）、心率（HR）水平均呈先上升后下降的趋势，两指标在组间各时间点比较差异均无统计学意义（P>0.05）。三组术后静息状态VAS评分均呈先上升后下降的趋势，在术后6 h、12 h、24 h，B组和C组的静息状态VAS评分均显著高于A组（P<0.05），在术后48 h，B组静息状态VAS评分仍显著高于A组，但A组与C组间比较差异无统计学意义（P>0.05）。三组术后运动状态VAS评分均呈先上升后下降的趋势，C组术后2 h、6 h、48 h的运动状态VAS评分显著高于A组（P<0.05），B组运动状态VAS评分仅在术后6 h显著高于A组（P<0.05）。与C组比较，A组和B组镇痛泵按压次数显著减少(P<0.05)。三组首次排气时间、恢复进食时间、首次下床时间和住院时间比较差异无统计学意义(P>0.05）。三组术后不良反应及神经阻滞相关并发症总发生率比较差异有统计学意义(P<0.05）。结论 右美托咪定联合罗哌卡因四点神经阻滞用于全身麻醉下腹腔镜肝肿瘤手术，虽然在术中各时间点血流动力学的影响无显著差异，但是提高了术后上腹部镇痛效果，减少了镇痛泵按压次数，且无明显不良反应，值得推广。 |
| 关键词: 右美托咪定 罗哌卡因 腹部神经阻滞 低位前锯肌平面阻滞 多模式镇痛 腹腔镜 肝肿瘤手术 |
| DOI：10.3969/j.issn.1674-3806.2024.04.04 |
| 分类号: |
| 基金项目:广西医疗卫生适宜技术开发与推广应用项目（编号：S2022008）；广西中医药适宜技术开发与推广项目（编号：GZSY22-58）；广西中医药管理局自筹科研课题（编号：GXZYZ20210558）；广西卫生健康委自筹经费科研课题（编号：Z20210258） |
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| A study on the application effect of dexmedetomidine combined with ropivacaine four-point nerve block on patients undergoing laparoscopic surgery of liver tumors |
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HUANG Liuqing, LU Liuyu, QIN Xiaotong, WANG Yonghao, KANG Xiaoyu, GONG Zheng
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Department of Anaesthesiology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To explore the application effect of dexmedetomidine combined with ropivacaine four-point nerve block on laparoscopic surgery of liver tumors. Methods A total of 84 patients undergoing laparoscopic surgery of liver tumors under general anesthesia in the People′s Hospital of Guangxi Zhuang Autonomous Region from August 2021 to July 2022 were selected and randomly divided into dexmedetomidine combined with ropivacaine group(group A, 30 cases), ropivacaine group(group B, 30 cases) and control group(group C, 24 cases). Both group A and group B underwent ultrasound-guided four-point nerve block in the right low serratus anterior, right transversus abdominis plane below the rib margin, and bilateral posterior rectus sheath, and group C did not receive any nerve block. The hemodynamic changes at the time for intraoperative anesthesia(T1), 5 minutes before skin incision(T2), 5 minutes after skin incision(T3), at the time for hepatectomy(T4) and at the time for skin suture(T5), and the Visual Analogue Scale(VAS) scores at rest and in motion within 48 hours after surgery(2 hours, 6 hours, 12 hours, 24 hours and 48 hours), the pressing times of the analgesic pump within 48 hours after surgery, and the occurrence of adverse reactions were compared among the three groups. Results At T1-T5 time points, the levels of mean arterial pressure(MAP) and heart rate(HR) showed a trend of first increasing and then decreasing in the three groups, and there were no statistically significant differences in the two indicators at different time points between groups(P>0.05). The VAS scores at rest showed a trend of first increasing and then decreasing in the three groups after surgery. The VAS scores at rest in group B and group C were significantly higher than those in group A at 6 hours, 12 hours and 24 hours after surgery(P<0.05). The VAS scores at rest in group B were still significantly higher than those in group A at 48 hours after surgery, but there were no statistically significant differences between group A and group C(P>0.05). The VAS scores in motion showed a trend of first increasing and then decreasing in the three groups after surgery. The VAS scores in motion in group C were significantly higher than those in group A at 2 hours, 6 hours and 48 hours after surgery(P<0.05). The VAS scores in motion in group B were significantly higher than those in group A only at 6 hours after surgery(P<0.05). Compared with group C, both group A and group B showed a significant reduction in the pressing times of the analgesic pump(P<0.05). There were no statistically significant differences in the first exhaust time, recovery time of diet, time of getting out of bed for the first time and hospitalization time among the three groups(P>0.05). There were statistically significant differences in the total incidence rate of postoperative adverse reactions and nerve block-related complications among the three groups(P<0.05). Conclusion Dexmedetomidine combined with ropivacaine four-point nerve block for laparoscopic surgery of liver tumors under general anesthesia has no significant differences in hemodynamic effects at various time points during the operation, but it improves postoperative upper abdominal analgesia, reduces the pressing times of the analgesic pump, and has no obvious adverse reactions, which is worthy of promotion. |
| Key words: Dexmedetomidine Ropivacaine Abdominal nerve block Low serratus anterior plane block Multimodal analgesia Laparoscopy Surgery of liver tumor |
