|本期目录/Table of Contents|

[1]张晓琴,詹锐,彭丽君.右美托咪定作为罗哌卡因佐剂用于腹横肌平面阻滞对剖宫产术后镇痛的影响[J].医学研究与战创伤救治(原医学研究生学报),2020,22(6):627-631.[doi:10.3969/j.issn.1672-271X.2020.06.015]
　ZHANG Xiao-qin,ZHAN Rui,PENG Li-jun.Effects of dexmedetomidine as an adjuvant to ropivacaine in transversus abdominis plane block on the postoperative analgesia following cesarean delivery[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(6):627-631.[doi:10.3969/j.issn.1672-271X.2020.06.015]
点击复制

右美托咪定作为罗哌卡因佐剂用于腹横肌平面阻滞对剖宫产术后镇痛的影响()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年6期
页码:
627-631
栏目:
临床研究
出版日期:
2020-11-20

文章信息/Info

Title:
Effects of dexmedetomidine as an adjuvant to ropivacaine in transversus abdominis plane block on the postoperative analgesia following cesarean delivery
作者:
张晓琴; 詹锐; 彭丽君
作者单位：242000宣城，宣城市人民医院麻醉科(张晓琴、詹锐、彭丽君)
Author(s):
ZHANG Xiao-qin;  ZHAN Rui; PENG Li-jun
(Department of Anesthesiology, Xuancheng City People′ Hospital, Xuancheng 242000, Anhui, China)
关键词:
右美托咪定; 罗哌卡因; 腹横肌平面阻滞; 术后镇痛; 剖宫产
Keywords:
dexmedetomidine; ropivacaine; transverse abdominal muscle block; postoperative analgesia; cesarean delivery
分类号:
R614.4
DOI:
10.3969/j.issn.1672-271X.2020.06.015
文献标志码:
A
摘要:
目的评估右美托咪定作为罗哌卡因佐剂行超声引导下腹横肌平面阻滞（TAPB）对腰麻下剖宫产术后镇痛效果的影响。方法选择2019年3月至2020年3月宣城市人民医院接诊的择期单次腰麻下行剖宫产产妇105例，年龄20～35岁，体重50～80 kg，采用随机数字表法将产妇随机均分为3组：单纯静脉舒芬太尼镇痛组（S组）、罗哌卡因组（RS组）、罗哌卡因＋右美托咪定组（RDS组），剔除不符合要求3例，每组34例。S组术后行舒芬太尼2.5 μg/kg静脉镇痛；RS组和RDS组除静脉镇痛外，均在术后行超声引导下TAPB，RS组行0.375%罗哌卡因每侧20 mL神经阻滞，RDS组行0.5 μg/kg右美托咪定+0.375%罗哌卡因每侧20 mL神经阻滞。记录并比较各组术后出现疼痛时间，要求追加镇痛药物产妇例数，术后6 h、12 h、24 h视觉模拟评分(VAS)疼痛评分及Ramsay镇静评分，产妇术后镇痛满意度，术后不良反应发生情况。结果RDS组出现疼痛时间较RS组明显延长[(659.8±214.7)min vs (218.7±59.3)min，P<0.01]，S组术后出现疼痛时间最短[(103.9±32.3)min]；S组要求追加镇痛药物产妇人数最多（6例）。RS组术后6 h的静息和运动VAS评分[(1.6±0.7)分、(2.5±0.7)分]较S组[(3.4±0.7)分、(4.3±0.8)分]降低（P<0.01）；RDS组12 h的静息与运动评分[(1.1±0.7)分、(2.0±0.7)分]较RS组[(3.3±0.5)分、(4.2±0.6)分]降低（P<0.01）；3组24 h的VAS评分比较差异无统计学意义（P>0.05），3组术后Ramsay镇静评分均为2级。S组术后镇痛满意度评分较RS组降低[(5.5±0.5)分 vs (6.8±0.4)分，P<0.01]，RDS组术后镇痛满意度评分最高[(8.4±0.5)分]。3组术后恶心、呕吐等不良反应发生率比较差异无统计学意义（P>0.05）。结论采用腋中线入路阻滞及横切口术式，右美托咪定作为罗哌卡因佐剂行TAPB用于腰麻下剖宫产术后镇痛，能延长镇痛持续时间并且改善质量，提高满意度。
Abstract:
ObjectiveTo evaluate the safety and efficacy of dexmedetomidine as an adjuvant to ropivacaine in transversus abdominis plane block on the postoperative analgesia following cesarean delivery under spinal anesthesia.MethodsFrom March 2019 to March 2020, 105 parturients in Xuancheng City People′ Hospital, aged 20-35 years, weight 50-80 kg, using a single lumbar hemp and undergoing cesarean section were randomized divided into three groups. Three cases that did not meet the requirements of this study were eliminated, 34 cases in each group: simple intravenous analgesia group (group S), ropivacaine group (group RS), dexmedetomidine + ropivacaine group (group RDS). The parturients in group S were treated with sufentanil 2.5 μg/kg. In addition to intravenous analgesia, both groups RS and RDS were received ultrasonically guided TAPB after surgery. Group RS was received 0.375% ropivacaine 20 mL for TAP block and dexmedetomidine 0.5 μg/kg mixed with 0.375% ropivacaine for TAP block in group RDS. Primary outcome measure was the time for the occurrence of postoperative pain, secondary outcome measure was the number of parturients requesting additional analgesia. The rest and motor visual analogue scale (VAS) scores, ramsay sedation score were evaluated at 6, 12 and 24 h after operation, the adverse reactions and the parturients postoperative analgesia satisfaction score were also recorded.ResultsThe time for postoperative pain of group RDS was significantly longer than group RS [(659.8±214.7)min vs (218.7±59.3)min，P<0.01]) and control group. Group S had the shortest period (103.9±32.3)min. The number of parturients requiring additional analgesics of group S was the maximum (6 cases). The VAS scores of rest and motor pain in group RS [(1.6±0.7)，(2.5±0.7)] were significantly lower than those in group S at 6 h [(3.4±0.7)，(4.3±0.8)，P<0.01]. Compared with group RS, VAS scores of rest pain and motor pain in group RDS [(1.1±0.7)，(2.0±0.7)] were decreased at 12 h [(3.3±0.5)，(4.2±0.6)，P<0.01]. There was no significant difference between the three groups in VAS scores at 24 h （P>0.05）. Postoperative analgesia satisfaction score of group S was lower than that of group RS [(5.5±0.5) vs (6.8±0.4)，P<0.01]. The satisfaction score in group RDS was the highest (8.4±0.5). Ramsay sedation scores and postoperative complications such as drowsiness, nausea, vomiting had no significant difference （P>0.05）.ConclusionUnder the condition of midaxillary approach block and transverse incision, dexmedetomidine as an adjuvant to ropivacaine for TAPB on the postoperative analgesia following cesarean delivery under spinal anesthesia can prolong the duration of analgesia and improve the quality and satisfaction of the parturient.

参考文献/References:

[1]Shafi S, Collinsworth AW, Copeland LA, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system[J]. JAMA Surg, 2018,153(8):757-763.
[2]袁丽丽,张燕燕,徐德朋,等.布托啡诺复合舒芬太尼在创伤患者术后镇痛中的应用[J].东南国防医药,2015,17(4):353-355.
[3]顾燕,蔡孟,宋云, 等.右美托咪定复合舒芬太尼用于重度子痫前期剖宫产产妇术后自控静脉镇痛的研究[J].上海交通大学学报（医学版),2018,38(7):784-787.
[4]王刚,杜洪印,丁梅,等.TAP阻滞联合布托啡诺PCIA用于全麻剖宫产术后镇痛的效果[J].中华麻醉学杂志,2019,39(2):189-191.
[5]Hebbard P．Subcostal transversus abdominis plane block under ultrasound guidance[J]．Anesth Analg，2008，106(2)：674-675．
[6]Hu X, Li J, Zhou R, et al. Dexmedetomidine Added to Local Anesthetic Mixture of Lidocaine and Ropivacaine Enhances Onset and Prolongs Duration of a Popliteal Approach to Sciatic Nerve Blockade[J]. Clin Ther, 2017, 39(1):89-97.
[7]Swami SS, Keniya VM, Ladi D, et al. Comparison of dexmedetomidine and clonidine (α2 agonist drμgs) as an adjuvant to local anaesthesia in supraclavicular brachial lexus block: A randomised double-blind pro-spective study[J]. Indian J Anaesth, 2012, 56(3):243-249.
[8]周立旺,毛华洁,周英,等.单次静脉注射亚麻醉剂量氯胺酮对乳腺癌患者术后早期情绪的影响[J].广东医学,2019,40(23):3265-3268.
[9]Uppal V, Sancheti S,Kalagara H. Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review[J]. Curr Anesthesiol Rep,2019, 9:479-487.
[10]杨蓉蓉,徐兴国,黄新冲,等.全麻联合硬膜外阻滞与腹横肌平面阻滞对结直肠癌根治术患者术后恢复的影响[J].医学研究生学报,2019,32(10):1070-1075.
[11]Tang C, Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic[J]. J Pain Res, 2017, 10:1899-1904.
[12]Brummelt CM, Norat MA, Palmisang JM, et al. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat[J].Anesthesiology,2008,109(3):502-511.
[13]孙世宇,陈明慧,沈伟军，等.右美托咪定复合罗哌卡因对肩关节镜手术中超声引导下臂丛上干和颈浅丛阻滞效果的影响[J].国际麻醉学与复苏杂志，2018,39(9):846-851.
[14]Singh R, Kumar N, Jain A, et al. Addition of clonidine to bupivacaine in transversus abdominis plane block prolongs postoperative analgesia after cesarean section[J]. J Anaesthesiol Clin Pharmacol，2016，32（4）:501-504.
[15]Pan W, Liu G, Li T, et al. Dexmedetomidine combined with ropivacaine in ultrasound-guided tranversus abdominis plane block improves postoperative analgesia and recovery following laparoscopic colectomyy[J]. Exp Ther Med，2020,19(4):2535-2542.
[16]胡正权,李娜,刘杰，等.右美托咪定复合罗哌卡因腹横肌平面阻滞在腹膜透析置管术中的效果[J].临床麻醉学杂志,2020,36(2):120-123.
[17]Aboelela MA, Kandeel AR, Elsayed U, et al. Dexme-detomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study[J]. Saudi J Anaesth, 2018, 12(2):297-303.
[18]陈瑜,黄道琼,李海燕，等.肝癌栓塞术后疼痛患者择时给药时间点的改进及效果[J].中华护理杂志,2019,54(3):393-395.
[19]Horn CC．Why is the neurobiology of nausea and vomiting so important? [J] Appetite,2008,50(2/3):430-434.
[20]张西龙,韩勇,栾翰林，等.右美托咪定对剖宫产术后恶心呕吐的影响[J].实用医学杂志,2018,34(15):2583-2586.
[21]马剑锋.腹横肌平面阻滞范围及机理的探讨[D].苏州大学,2017.

相似文献/References:

[1]阮丁异,张 铨,陈明华,等.低浓度罗哌卡因腰-硬联合阻滞在椎间盘摘除术的应用[J].医学研究与战创伤救治(原医学研究生学报),2010,12(02):155.
[2]王祥和,陈 韬,张群英,等.相同剂量不同浓度罗哌卡因用于肌间沟臂丛阻滞观察[J].医学研究与战创伤救治(原医学研究生学报),2010,12(03):200.
　WANG Xiang-he,CHEN Tao,ZHANG Qun-ying,et al.Observation of the intersclance brachial plexus block anesthesia with same dosage and different concentrations of ropivacaine[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2010,12(6):200.
[3]卢承志,姚猛飞,宋 伟,等.罗哌卡因腰硬联合麻醉用于老年患者前列腺手术临床观察[J].医学研究与战创伤救治(原医学研究生学报),2010,12(03):212.
　LU Cheng-zhi,YAO Meng-fei,SONG Wei,et al.Clinical observation of spinal and epidural anesthesia using ropivacaine in operation of prostate for elderly patients[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2010,12(6):212.
[4]宗 林,赵 兵,王建国,等.罗哌卡因与布比卡因行连续蛛网膜下腔 麻醉的效果观察[J].医学研究与战创伤救治(原医学研究生学报),2009,11(02):107.
　ZONG Lin,ZHAO Bing,WANG Jian-guo,et al.Study of isobaric bupivacaine and ropivacaine in continuous spinal anesthesia for abdominal operation[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2009,11(6):107.
[5]蔡锦全,陈书尚,朱凌峰,等.罗哌卡因局部浸润缓解经皮肾镜取石术后疼痛的前瞻性研究[J].医学研究与战创伤救治(原医学研究生学报),2015,17(04):365.[doi:10.3969/j.issn.1672-271X.2015.04.009]
　CAI Jin-quan,CHEN Shu-shang,ZHU Ling-feng,et al.Alleviating postoperative pain in patients with percutaneous nephrolithotomy by using local anesthetic infiltration of ropivacaine[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(6):365.[doi:10.3969/j.issn.1672-271X.2015.04.009]
[6]陈锁芹,李丹丹,胡小燕,等.小剂量右美托咪定滴鼻在经桡动脉行冠心病介入治疗的应用及护理[J].医学研究与战创伤救治(原医学研究生学报),2017,19(01):96.[doi:10.3969/j.issn.1672-271X.2017.01.027]
[7]钱志峰,毛发江,徐磊,等.右美托咪定联合地佐辛镇痛方案对腹腔镜胆囊切除术患者的镇痛、炎性细胞因子及术后认知功能的影响探究[J].医学研究与战创伤救治(原医学研究生学报),2017,19(02):187.[doi:10.3969/j.issn.1672-271X.2017.02.019]
[8]戴少彬,赖燕云,黄琪玲,等.罗哌卡因蛛网膜下腔阻滞对超高龄髋关节患者术后认知功能的影响[J].医学研究与战创伤救治(原医学研究生学报),2017,19(06):633.[doi:10.3969/j.issn.1672-271X.2017.06.018]
[9]惠康丽,郭章宝,黄书翰,等.右美托咪定和咪达唑仑对前循环大血管闭塞支架取栓术后早期神经功能改善的影响[J].医学研究与战创伤救治(原医学研究生学报),2019,21(01):53.[doi:10.3969/j.issn.1672-271X.2019.01.012]
　HUI Kang-li,GUO Zhang-bao,HUANG Shu-han,et al.Effect of dexmedetomidine and midazolam on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(6):53.[doi:10.3969/j.issn.1672-271X.2019.01.012]
[10]洪勇,周民伟,徐化交.罗哌卡因经原癌基因信号通路抑制胃癌细胞增殖和迁移的机制[J].医学研究与战创伤救治(原医学研究生学报),2020,22(5):456.[doi:10.3969/j.issn.1672-271X.2020.05.002]
　HONG Yong,ZHOU Min-wei,XU Hua-jiao.The mechanism of ropivacaine inhibiting the proliferation and migration of gastric cancer cells via c-MYC signaling pathway[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(6):456.[doi:10.3969/j.issn.1672-271X.2020.05.002]

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2020-12-01