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| 右美托咪定复合罗哌卡因腹横肌平面阻滞对老年患者结直肠癌根治术后早期恢复质量的影响 |
| Effect of dexmedetomidine combined with ropivacaine for transverses abdominis plane block in early recovery quality of elderly patients undergoing colorectal resection |
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| DOI：10.12089/jca.2020.02.010 |
| 中文关键词: 右美托咪定 腹横肌平面阻滞 老年 恢复质量 |
| 英文关键词: Dexmedetomidine Transverses abdominis plane block Elderly Recovery quality |
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| 中文摘要: |
目的 探讨右美托咪定复合罗哌卡因腹横肌平面阻滞(TAPB)对老年结直肠癌根治术患者术后早期恢复质量的影响。
方法 择期全麻下行腹腔镜下结直肠癌根治术患者60例,男33例,女27例,年龄65～85岁,BMI 19～25 kg／m2,ASA Ⅱ或Ⅲ级,采用随机数字表法分为罗哌卡因组(C组)和右美托咪定复合罗哌卡因组(D组),每组30例。两组于麻醉诱导前在超声引导下行双侧TAPB，C组给予0.375％罗哌卡因,每侧20 ml;D组给予0.375％罗哌卡因+右美托咪定0.5 μg／kg,每侧20 ml。术后连接自控静脉镇痛泵(吗啡50 mg稀释至50 ml)作为补救镇痛,PCA剂量1 ml,锁定时间5 min,无背景输注。分别于术前1 d及术后3 d进行40项恢复质量(QoR-40)及匹兹堡睡眠质量指数(PSQI)评分。记录术后首次补救镇痛时间、吗啡消耗量及不良反应的发生情况。
结果 与C组比较,D组术后3 d QoR-40量表评分中身体舒适度、情绪状态、心理支持、疼痛及总评分明显升高,PSQI评分和吗啡消耗量明显降低，术后首次补救镇痛时间明显延长(P＜0.05)。两组术后不良反应发生率差异无统计学意义。
结论 右美托咪定复合罗哌卡因腹横肌平面阻滞可有效提高老年结直肠癌根治术患者术后早期睡眠及恢复质量,有利于老年患者术后康复。 |
| 英文摘要: |
Ojective To investigate the effect of dexmedetomidine combined with ropivacaine for transverses abdominis plane block (TAPB) in early recovery quality of elderly patients undergoing colorectal resection.
Methods Sixty patients scheduled for laparoscopic-assisted colorectal resection, 33 males and 27 females, aged 65-85 years, with a BMI 19-25 kg／m2, falling into ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups (n = 30 each) using a random number table: ropivacaine group (group C) and dexmedetomidine combined with ropivacaine group (group D). All the patients received bilateral ultrasound-guided TAPB before the induction of general anesthesia. The analgesia solution contained 0.375％ ropivacaine (each side 20 ml) in group C, whereas 0.375％ ropivacaine and 0.5 μg／kg dexmedetomidine (each side 20 ml) in group D. Patient-controlled intravenous analgesia (PCIA) pump, which contained morphine 1 mg／ml diluted to 50 ml normal saline, was connected for remedial analgesia. PCIA pump was set up to deliver 1 ml dose with a 5 min lockout interval and no background infusion. The postoperative early recovery and sleep quality were assessed by Quality of Recovery-40 (QoR-40) and Pittsburgh sleep quality index (PSQI) at 24 h before operation and 72 h after operation. The time to first rescue analgesia, morphine consumption and postoperative complications were recorded.
Results Compared with group C, the physical comfort score, emotional state score, psychological support score, pain score and the global QoR-40 scores were higher 3 d after surgery, whereas the PSQI and the morphine consumption were decreased significantly in group D (P ＜ 0.05). The time to first rescue analgesia was prolonged significantly in group D (P ＜ 0.05). The postoperative complications had no difference between the two groups.
Conclusion Dexmedetomidine combined with ropivacaine for ultrasound-guided TAPB can improve the postoperative early recovery and sleep quality, and benefit the postoperative rehabilitation for elderly patients undergoing colorectal resection. |
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