摘要
目的评价不同剂量右美托咪定混合罗哌卡因腹横肌平面阻滞(TAPB)用于全麻腹腔镜手术患儿的效果。方法择期行单通道腹腔镜阑尾切除术患儿80例,性别不限,年龄3~6岁,体重10~30 kg。采用随机数字表法分为4组(n=20):0.5μg/kg右美托咪定混合罗哌卡因组(DR1组)、1.0μg/kg右美托咪定混合罗哌卡因组(DR2组)、1.5μg/kg右美托咪定混合罗哌卡因组(DR3组)和罗哌卡因组(R组)。麻醉诱导结束后在超声引导下行双侧TAPB,R组注射0.25%罗哌卡因0.5 ml//kg,DR1组、DR2组和DR3组分别注射0.5、1.0和1.5μg/kg右美托咪定与罗哌卡因混合液0.5 ml/kg,罗哌卡因终浓度为0.25%。术中采用瑞芬太尼和七氟醚维持麻醉,间断静脉注射顺式阿曲库铵维持肌松。口服布洛芬维持术后FLACC评分<4分。记录术中瑞芬太尼用量、气管拔管时间、恢复室驻留时间、布洛芬使用情况及阿片类药物和TAPB相关并发症发生情况。结果4组术中瑞芬太尼用量和气管拔管时间差异无统计学意义(P>0.05)。与R组比较,DR2组和DR3组布洛芬使用率降低,DR3组恢复室驻留时间延长(P<0.05),DR1组布洛芬使用率、DR1组和DR2组恢复室驻留时间差异无统计学意义(P>0.05)。与DR1组比较,DR3组恢复室驻留时间延长,布洛芬使用率降低,DR2组布洛芬使用率降低(P<0.05),恢复室驻留时间差异无统计学意义(P>0.05)。与DR2组比较,DR3组恢复室驻留时间延长(P<0.05),其余指标比较差异无统计学意义(P>0.05)。均未见阿片类药物及TAPB相关并发症发生。结论1.0μg/kg右美托咪定混合罗哌卡因TAPB用于全麻腹腔镜手术患儿的效果较好。
Objective To evaluate the efficacy of transversus abdominis plane block(TAPB)with different doses of dexmedetomidine mixed with ropivacaine in the pediatric patients undergoing laparoscopic surgery with general anesthesia.Methods Eighty patients of both sexes,aged 3-6 yr,weighing 10-30 kg,scheduled for elective single-channel laparoscopic appendectomy,were divided into 4 groups(n=20 each)using a random number table method:0.5μg/kg dexmedetomidine plus ropivacaine group(group DR1),1.0μg/kg dexmedetomidine plus ropivacaine group(group DR2),1.5μg/kg dexmedetomidine plus ropivacaine group(group DR3),and ropivacaine group(R group).Bilateral TAPB was performed under ultrasound guidance after the end of anesthesia induction.In group TR,0.25%ropivacaine 0.5 ml/kg was injected,the 0.5 ml/kg mixture of 0.5,1.0 and 1.5μg/kg dexmedetomidine and ropivacaine at a final concentration of 0.25%was injected in DR1,DR2 and DR3 groups.Anesthesia was maintained by intravenously infusing remifentanil and inhaling sevoflurane.Cisatracurium was intermittently injected to maintain muscle relaxation.Ibuprofen was taken orally to maintain postoperative FLACC score<4.The intraoperative consumption of remifentanil,tracheal extubation time,duration of anesthetic recovery room stay,requirement for ibuprofen,and occurrence of opioids-and TAPB-related complications were recorded.Results There was no significant difference in the intraoperative consumption of remifentanil or tracheal extubation time between four groups(P>0.05).Compared with group R,the requirement for ibuprofen was significantly decreased in DR2 and DR3 groups,the duration of anesthetic recovery room stay was significantly prolonged in group DR3(P<0.05),and no significant change was found in the requirement for ibuprofen in group DR1 or in the duration of anesthetic recovery room stay in DR1 and DR2 groups(P>0.05).Compared with group DR1,the duration of anesthetic recovery room stay was significantly prolonged,and the requirement for ibuprofen was decreased in group DR3,and the requirement for ibuprofen was significantly decreased(P<0.05),and no significant change was found in the duration of anesthetic recovery room stay in group DR2(P>0.05).Compared with group DR2,the duration of anesthetic recovery room stay was significantly prolonged(P<0.05),and no significant change was found in the other parameters in group DR3(P>0.05).No patients developed opioids-or TAPB-related complications.Conclusion TAPB with 1.0μg/kg dexmedetomidine mixed with ropivacaine provides good efficacy for the pediatric patients undergoing laparoscopic surgery with general anesthesia.
作者
姚忠岩
瞿敏
杨强
汤国亮
刘问宾
于丽丽
Yao Zhongyan;Qu Min;Yang Qiang;Tang Guoliang;Liu Wenbin;Yu Lili(Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Anesthesiology,Nanpi County People′s Hospital,Nanpi 061500,China;Department of Anesthesiology,Traditional Chinese Medicine Hospital of Huanghua City,Huanghua 061100,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第8期970-973,共4页
Chinese Journal of Anesthesiology
