摘要
目的观察不同剂量右美托咪定(Dex)复合罗哌卡因腹腔内雾化及切口注射对腹腔镜胆囊切除术(LC)术后镇痛的影响。方法 80例择期行LC手术患者,根据随机双盲法分为Ⅰ、Ⅱ、Ⅲ组及C组,每组20例。各组均于术毕前将15 ml药液雾化喷洒术野周围腹腔,9 ml药液行切口注射;C组药液含0.3%罗哌卡因,Ⅰ组药液含0.5μg/kg右美托咪定+0.3%罗哌卡因,Ⅱ组含1.0μg/kg右美托咪定+0.3%罗哌卡因,Ⅲ组含1.5μg/kg右美托咪定+0.3%罗哌卡因。观察各组手术时间、术后苏醒时间、拔除喉罩拔管时间;术后1、4、8、12和24 h的心率(HR)、平均动脉压(MAP)、视觉模拟评分法(VAS)评分和Ramsay镇静评分;术后镇痛药物的使用情况和不良反应发生情况。结果各组患者手术时间比较差异无统计学意义(P>0.05);Ⅰ、Ⅱ组术后苏醒时间、拔除喉罩拔管时间与C组比较差异无统计学意义(P>0.05),Ⅲ组患者术后苏醒时间、拔除喉罩拔管时间较C组延迟(P<0.05)。各组患者术后24 h MAP比较差异无统计学意义(P>0.05);Ⅲ组患者术后1 h HR较其他三组降低(P<0.05);C组患者术后4、8、12 h VAS评分高于术后1 h,Ⅰ、Ⅱ、Ⅲ组患者术后4、8、12 h VAS评分低于同时间C组患者(P<0.05);Ⅱ、Ⅲ组患者术后24 h VAS评分低于同时间C组患者(P<0.05);C组患者术后4、8、12 h的Ramsay评分低于术后1 h(P<0.05),Ⅲ组患者术后12、24 h的Ramsay评分低于术后1 h(P<0.05),Ⅱ、Ⅲ组患者术后1、4、8、12 h的Ramsay评分高于同时间C组患者(P<0.05)。Ⅰ、Ⅱ、Ⅲ组患者首次使用镇痛药物时间较C组延长(P<0.05);Ⅰ、Ⅱ、Ⅲ组患者术后24 h内镇痛药物使用总量少于C组(P<0.05)。C、Ⅰ、Ⅱ、Ⅲ组患者术后24 h内恶心、呕吐发生率分别为25%(5/20)、10%(2/20)、5%(1/20)、5%(1/20),Ⅰ、Ⅱ、Ⅲ组患者不良反应发生率均明显低于C组(P<0.05),Ⅰ、Ⅱ、Ⅲ组患者不良反应发生率两两比较差异无统计学意义(P>0.05)。结论三种浓度的右美托咪定联合罗哌卡因腹腔内雾化及切口注射可有效的抑制LC术后疼痛。其中1.0μg/kg右美托咪定能延长镇痛时间,减少额外镇痛药物应用,不良反应少,且不明显延长术后苏醒时间等。
Objective To observe the effect of different doses of dexmedetomidine combined with ropivacaine intraperitoneal atomization and incision injection on postoperative analgesia after laparoscopic cholecystectomy （LC）. Methods A total of 80 patients with selected LC surgery were divided by random double-blind method into groupⅠ, groupⅡ, groupⅢand group C, with 20 cases in each group. 15 ml liquid was atomized and sprayed around the peritoneal cavity before operation in each group, and 9 ml liquid was injected through the incision. Group C contained 0.3% ropivacaine, groupⅠcontained 0.5 g/kg dexmedetomidin ＋0.3% ropivacaine, groupⅡcontained 1.0 μg/kg dexmedetomidin ＋ 0.3% ropivacaine, and groupⅢcontained 1.5 μg/kg dexmedetomidin ＋ 0.3% ropivacaine. Observation were made on operation time, postoperative wake-up time, extraction of the laryngeal mask time, heart rate （HR） , mean arterial pressure （MAP）, visual analogue score （VAS） and Ramsay sedation score of postoperative 1, 4, 8, 12 and 24 h, use of postoperative analgesic drugs and occurrence of adverse reaction between the two groups. Results All groups had no statisticallysignificant difference in operation time （P〉0.05）. GroupⅠand groupⅡhad no statistically significant difference in postoperative wake-up time, extraction of the laryngeal mask time, comparing with group C （P〉0.05）. Group Ⅲ had delayed postoperative wake-up time and extraction of the laryngeal mask time than group C （P〈0.05）. All groups had no statistically significant difference in MAP of postoperative 24 h （P〉0.05 ）. Group Ⅲ had lower HR of postoperative 1 h than the other three groups （P〈0.05）. Group C had higher VAS score of postoperative 4, 8, 12 h than postoperative 1 h, and group Ⅰ, group Ⅱ and group Ⅲ had lower VAS score of postoperative 4, 8, 12 h than those of group C （P〈0.05）. Group Ⅱ and group Ⅲ had lower VAS score of postoperative 24 h than those of group C （P〈0.05）. Group C had lower Ramsay score of postoperative 4, 8, 12 h than that of postoperative 1 h （P〈0.05）. Group Ⅲ had lower Ramsay score of postoperative 12 and 24 h than that of postoperative 1 h （P〈0.05）, and group Ⅱ and group Ⅲ had higher Ramsay score of postoperative 1, 4, 8, 12 h than that of group C （P〈0.05）. Group Ⅰ, group Ⅱ and group Ⅲ had prolonged duration of first use of analgesic drugs than group C （P〈0.05）. Group Ⅰ, group Ⅱ and group Ⅲ had less total amount of analgesic drugs of postoperative 24 h than group C （P〈0.05）. Group C, group Ⅰ, group Ⅱ and group Ⅲ had incidence of nausea and vomiting of postoperative 24 h respectively as 25% （5/20）, 10% （2/20）, 5% （1/20） and 5% （1/20）, and group Ⅰ, group Ⅱ and group Ⅲ had obviously lower incidence of adverse reactions than group C （P〈0.05）. Group Ⅰ, group Ⅱ and group Ⅲ had no P〉 Conclusionof dexmedetomidine combined with ropivacaine intraperitoneal atomization and incision injection can effectively inhibit postoperative pain in LC. Among them, 1.0 μg/kg dexmedetomidine can prolong the time of analgesia, reduce the application of additional analgesic drugs with fewer adverse reactions, and there is no obvious prolonged wake-up after operation.
作者
谭珊珊
胡婷婷
姚泽明
朱珊珊
TAN Shan-shan;HU Ting-ting;YAO Ze-ming(Department of Anesthesia, Xuzhou Tumor Hospital, Xuzhou 221000, China)
出处
《中国现代药物应用》
2018年第9期8-11,共4页
Chinese Journal of Modern Drug Application
基金
徐州市推动科技创新后补助备案项目(项目编号:KC16SH108)
关键词
右美托咪定
罗哌卡因
胆囊切除
术后镇痛
Dexmedetomidine
Ropivacaine
Cholecystectomy
Postoperative analgesia
