超声引导下局麻药复合右美托咪定腹横肌平面阻滞在妇科开腹手术患者中的应用效果.docVIP

超声引导下局麻药复合右美托咪定腹横肌平面阻滞在妇科开腹手术患者中的应用效果 　　[摘要] 目的 探?超声引导下局麻药复合右美托咪定腹横肌平面阻滞（TAPB）在妇科开腹手术患者中的应用效果。 方法 选取2014年10月～2016年8月于广东省中医院行开腹子宫和卵巢囊肿切除术的患者90例作为研究对象，按随机数字表法将其分为三组：对照组（C组）、局麻药组（T组）和局麻药复合右美托咪定组（DT组），每组30例。三组患者均行常规气管插管全身麻醉，在此基础上，T组和DT组于麻醉诱导结束后行B超引导下双侧TAPB，其中T组和DT组分别注射0.4%罗哌卡因30 mL和0.4%罗哌卡因复合0.75 μg/kg右美托咪定30 mL。比较三组患者自主呼吸恢复时间、苏醒时间及拔管时间，记录术后视觉模拟评分（VAS）、镇静评分（Ramsay评分）以及不良反应发生情况，观察双侧阻滞侧温觉平面阻滞率。所得数据采用统计学软件SPSS 18.0分析处理。 结果 与C组比较，T组和DT组丙泊酚用量减少，自主呼吸恢复时间、苏醒时间和拔管时间缩短，术后8、12、24 h（T1～T3）时间点VAS评分降低（P 0.05）。T组、DT组术后24 h时阻滞侧温觉平面阻滞率分别为76.7%、86.7%。 结论 B超引导下局麻药复合右美托咪定TAPB在妇科开腹手术中的麻醉恢复快，术后镇痛效果较好，且精准和安全性高。 　　[关键词] 右美托咪定；罗哌卡因；超声；腹横肌平面阻滞；妇科开腹手术；术后镇痛 　　[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2017）12（a）-0062-04 　　[Abstract] Objective To explore application effects of ultrasound-guided transversus abdominis plane blocks （TAPB） with local anesthetics and Dexmedetomidine in patients with gynecological laparotomy. Methods Ninety patients underwent hysterectomy and ovarian cyst resection in Guangdong Hospital of Traditional Chinese Medicine from October 2014 to August 2016 were selected as research objects， and they were randomly divided into three groups by random number table： control group （group C）， local anesthetic medicine group （T group）， local anesthetics and Dexmedetomidine group （DT group）， with 30 cases in each group. Patients in three groups were treated with normal endotracheal intubation and general anesthetic. After induction of anesthesia， B ultrasound-guided bilateral TAPB were performed in T group and DT group. The patients in T group and DT group were respectively injected with 30 mL of 0.4% Ropivacaine and 30 mL of 0.4% Ropivacaine combined with 0.75 μg/kg Dexmedetomidine. The recovery time of spontaneous breathing， waking time and extubation time of the three groups were compared， and postoperative visual analogue scale （VAS）， Ramsay score and the incidence of adverse reactions were recorded， and the rates of temperature plane block in bilateral block sides were obse