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。

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.

目的 研究地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用。方法 选择择期行腹式子宫切除术患者60例(ASA I ~Ⅱ级),随机分成三组。所有患者给予腰麻,麻醉平面调节并固定于T₆后,给予A组患者0.1 mg/kg地佐辛,静脉注射;B组静脉注射0.1 mg/kg地佐辛后丙泊酚持续泵注2~4 mg/(kg·h);C组单次静注丙泊酚1.5 mg/kg后持续泵注2~4mg/(kg·h)。记录麻醉前(T₀)、腰麻平面固定后(T₁)、静注药物后5min(T₂)、切皮(T₃)、牵拉子宫时(T₄)、术毕(T₅)患者的HR、MAP及Ramesay镇静评分;评价肌松效果、牵拉反应、患者舒适度及满意度。结果 三组患者一般情况无差异(P＞0.05);与T₀相比,Ⅲ组T₂及T₅时刻MAP与T₀相比差异有统计学意义(P＜0.05),T₂、 T₃ 、T₄及T₅时刻HR与T₀相比差异有统计学意义(P＜0.05);与T₀相比,Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、 T₃及T₄时刻均升高,差异有统计学意义(P＜0.05);Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、T₃及T₄时刻高于I组,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少于II组及III组,评为良及差的患者个数多于II组及III组,此差异有统计学意义(P＜0.05);II组及III组舒适度及满意度评定为优的患者个数明显多余I组,差异有统计学意义(P＜0.05)。结论 0.1 mg/kg地佐辛复合丙泊酚可以很好预防腹式子宫切除手术中的牵拉反应,提高患者舒适度和满意度。

Objective To observe whether dezocine combined with propofol can prevent intra operative dragging reaction during hysterectomy or not. Methods Sixty patients(ASAⅠ~Ⅱ)which through hysterectomy surgery were randomly arranged to 3 groups. All the patients were under spinal anesthesia, adjusted the anesthesia plane to T6. Group l: dezocine 0.1 mg/kg were intravenous injected, Group ll: dezocine 0.1 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h were intravenous pumped, Group lll: propofol 1.5 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h intravenous were pumped. HR、MAP and Ramesay scale were recorded at the time points of pre-anesthesia(T₀)、pre-injection(T₁)、5 min after injection(T₂)、skin incision(T₃)、dragging uterus(T₄)、after surgery(T₅),the effect of muscle relaxation and the reaction of patients were recorded in the mean time, comfort degree and satisfaction degree of patients were evaluated after surgery. Results There was no significant difference of general condition between the three groups (P>0.05). At the time point of T₂ and T₅, MAP of Group lll patients were significant lower than the base value(P<0.05). At the time point of T₂、T₃、T₄ and T₅, HR of Group lll patients were significant lower then base value(P<0.05). Dragging reaction during the surgery were significant reduced in Group ll and Group lll but not in Group l(P<0.05). Group ll and Group lll patients felt more comfortable and more satisfied than Group l patients(P<0.05). Conclusion 0.1 mg/kg dezocine combined with propofol can prevent intra operative dragging reaction and make patient feel more comfortable during hysterectomy.