文章摘要
腹横肌平面阻滞联合右美托咪定复合舒芬太尼静脉镇痛对肝部分切除术后早期康复的影响
Effects of continuous intravenous analgesia with transversus abdominis plane block combined with dexmedetomidine and sufentanil on the recovery after partial hepatectomy
  
DOI：10.12089/jca.2018.12.005
中文关键词: 术后镇痛  腹横肌平面阻滞  右美托咪定  舒芬太尼  加速康复外科
英文关键词: Postoperative analgesia  Transversus abdominis plane block  Dexmedetomidine  Sufentanil  Enhanced recovery after surgery
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作者单位E-mail
笪磊 230000,合肥市,中国科学技术大学附属第一医院麻醉科（现在宣城市人民医院麻醉科）  
谢言虎 230000,合肥市,中国科学技术大学附属第一医院麻醉科 xyh200701@sina.cn 
柴小青 230000,合肥市,中国科学技术大学附属第一医院麻醉科  
章蔚 230000,合肥市,中国科学技术大学附属第一医院麻醉科  
魏昕 230000,合肥市,中国科学技术大学附属第一医院麻醉科  
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中文摘要:
      
目的 评估腹横肌平面阻滞(transversus abdominis plane block, TAPB)联合舒芬太尼、右美托咪定用于肝部分切除患者术后镇痛的效果和安全性, 探讨其对患者术后早期康复的影响。
方法 选择择期行肝部分切除术患者60例,男31例，女29例，年龄20～65岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组,术后自愿行静脉自控镇痛，A组舒芬太尼2 μg/kg;B组右美托咪定1 μg/kg+舒芬太尼2 μg/kg。两组均行超声引导下TAPB，给予0.375%罗哌卡因20 ml。记录术后48 h内VAS疼痛评分和Ramsay镇静评分，术后肠道恢复通气时间、术后进食时间、术后住院时间及并发症发生情况等。
结果 与A组比较, B组术后12、24 h静息VAS评分及术后12、48 h运动VAS评分明显降低(P<0.05)；B组术后首次排气时间、术后进食时间、术后住院时间明显缩短(P<0.05)。两组术后Ramsay镇静评分及恶心、呕吐、低血压、心动过缓、呼吸抑制、肺部感染等发生率差异无统计学意义。
结论 对于行肝部分切除手术的患者,TAPB联合右美托咪定复合舒芬太尼用于术后镇痛可加速患者术后早期康复。
英文摘要:
      
Objective To assess the effect, safety and early postoperative recovery of sufentanil and transversus abdominis plane block (TAPB) combined with dexmedetomidine for postoperative analgesia for patients undergoing partial hepatectomy.
Methods Sixty patients, 31 males and 29 females, aged 20 - 65 years, BMI 18 - 25 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, undergoing partial hepatectomy and using patient-controlled intravenous analgesia (PCIA) voluntarily were randomized divided into two groups. The patients in group A were treated with sufentanil through PCIA, the patients in group B were treated with sufentanil and dexmedetomidine through PCIA. The patients in the two groups received ultrasound-guided TAPB with 0.375% ropivacaine 20 ml. The changes of VAS and Ramsay scores, postoperative intestinal function recovery time, feeding time, length of hospital stay, respiratory and circulatory system complications were recorded.
Results Compared with group A, VAS scores at rest 12 hours and 24 hours and in activity 12 hours and 48 hours postoperatively were significantly decreased in group B (P < 0.05). Compared with group A, the postoperative intestinal function recovery time, feeding time and length of hospital stay were significantly shortened in group B (P < 0.05). Ramsay scores and postoperative complications such as nausea, emisis, hypotension, bradycardia, respiratory depression and pulmonary infection had no significant difference.
Conclusion For patients undergoing partial hepatectomy, sufentanil and TAPB combined with dexmedetomidine for postoperative analgesia could enhance early postoperative recovery progress.
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