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

doi:10.3969/j.issn.1000-8535.2016.04.012

广州医药 ›› 2016, Vol. 47 ›› Issue (4): 39-41.DOI: 10.3969/j.issn.1000-8535.2016.04.012

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

何莉, 唐晶晶

广州市第一人民医院(广州 510180)

收稿日期:2016-02-19 出版日期:2016-07-20 发布日期:2021-12-02

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

He Li, Tang Jingjing

Guangzhou First People's Hospital, Guangzhou 510180,China

Received:2016-02-19 Online:2016-07-20 Published:2021-12-02

摘要/Abstract

摘要： 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0.5 μg/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。

关键词: 右旋美托咪啶, 腹横肌膜神经阻滞, 阴式子宫切除术

Abstract: 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 ultrasound-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. Results 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 significant 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 ropivacaine is effective and safe for vaginal hysterectomy in elderly female.

Key words: Dexmedetomidine, Transverses abdominis plane block, Vaginal hysterectomy

何莉, 唐晶晶. 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[J]. 广州医药, 2016, 47(4): 39-41.

He Li, Tang Jingjing. Effect of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy[J]. Guangzhou Medical Journal, 2016, 47(4): 39-41.

参考文献

[1] DE CRANE SK, SANDS L, ASHLAND M, et al. Factors associated with re-coverv from early postoperative delirium[J]. J Perianesth Nurs, 2011,26(4):231-241.
[2] 张立冬. 硬膜外阻滞复合静脉全麻在腹腔镜辅助阴式子宫全切术中的应用[J]. 辽宁医学杂志,2012,26(5):233-236.
[3] MILAN ZB, DUNCAN B, REWARI V, et al. Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients [J]. Transplant Proc, 2011, 43(7): 2687-2690.
[4] WU Y, LIU F, TANG H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy [J]. Anesth Anlg, 2013, 117(2): 507-513.
[5] MARIA W, DARIUSZ M. Use of dexmedetomidine in the adult intensive care unit[J]. Anaeshtesiol Intesive Ther, 2013,45(4):235-240.
[6] XU L, HU Z, SHEN J, et al. Does dexmedelomidine have a cardiac protective effect during non -cardiac surgery? A randomised controlled trial[J]. Clin Exp Pharmacol Physiol, 2014,41(11):879-883.
[7] J AFONSO,F REIS. Dexmedetomidine: current role in anesthesia and intensive care[J]. Rev Bras Anestesiol, 2012, 62(1): 118-133.
[8] SANDERS RD, SUN P, PATEL S, et al. Dexmedetomidine provides corti-cal neuroprotection:impact on anaesthetic-induced neuroapoptosis in the rat developing brain[J]. Acta Anesthesiol Scand, 2010, 54 (6):710-716.
[9] 周俊, 王龙, 郭毅,等. 右美托咪啶与咪达唑仑对老年患者术后谵妄影响的系统评价[J]. 海南医学,2015,26(2):277-280.
[10] ESMAOGLU A, YEGENOGLU F, AKIN A, et al. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block[J]. Anesth Analg, 2010, 111(6): 1548-1551.
[11] ARORA SS, GOOCH JL, GARCIA PS. Postoperative cognitive dysfunction, Alzheimer's disease, and anesthesia[J]. Int J Neuro,2014, 124(4):236-242.
[12] 张大志, 王东信. 麻醉对术后谵妄的影响[J]. 临床麻醉学杂志, 2014, 30(1):97-99.

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

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

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

编辑推荐

Metrics

本文评价