摘要
目的评价右美托咪定联合罗哌卡因腹横肌平面阻滞对老年患者腹腔镜手术后谵妄的影响。方法选择择期行腹腔镜胃癌根治术的老年患者120例, ASAⅡ~Ⅲ级,年龄65~80岁,随机分为3组(n=40):单纯全麻组(G组)、罗哌卡因腹横肌平面阻滞组(R组)和右美托咪定联合罗哌卡因腹横肌平面阻滞组(DR组)。G组行单纯全麻, DR组和R组在麻醉诱导前于超声引导下行双侧腹横肌平面阻滞, DR组每侧注射0.25%罗哌卡因复合右美托咪定(1μg·kg-1) 25 mL, R组每侧注射0.25%罗哌卡因25 mL。3组均采用静脉复合全身麻醉,术后均予以静脉自控镇痛。记录手术时间和术中出血量、输液量、丙泊酚及瑞芬太尼的用量,以及术后24 h舒芬太尼的用量,评估术后6、 12、 24、 48 h疼痛视觉模拟量表(VAS)评分和术后3 d内患者谵妄的发生情况。观察并记录不良反应发生情况。结果与G组相比, DR组术中丙泊酚用量显著减少(P <0.05),且DR组术中瑞芬太尼用量显著少于R组和G组(P <0.05)。与G组相比, DR组和R组术后24 h舒芬太尼的用量显著减少(P <0.05), DR组术后6、 12 h的VAS评分显著降低(P <0.05), R组术后6 h的VAS评分显著降低(P <0.05)。与G组相比, DR组术后3 d内谵妄的发生率显著降低(28%vs. 8%, P <0.05),术后恶心呕吐和苏醒期躁动的发生率降低(P <0.05), 3组均无呼吸抑制发生。结论右美托咪定复合罗哌卡因腹横肌平面阻滞可减少老年腹腔镜胃癌根治术患者术后谵妄的发生,减少术中全麻药用量,术后镇痛效果佳。
AIM To evaluate the effects of dexmedetomidine mixed with ropivacaine for transversus abdominis plane block on postoperative delirium in elderly patients undergoing laparoscopic radical gastrectomy.METHODS One hundred and twenty elderly patients undergoing laparoscopic radical gastrectomy, ASA Ⅱ orⅢ, aged 65-80 years, were randomly divided into 3 groups(n = 40 each): simple general anesthesia group(group G), ropivacaine for transversus abdominis plane block group( group R) and dexmedetomidine mixed with ropivacaine for transversus abdominis plane block(group DR). Simple general anesthesia was provided in group G. Before anesthesia induction, ultrasound guided bilateral transversus abdominis plane block was performed in group DR and group R, 25 mL of 0.25% ropivacaine mixed with dexmedetomidine 1 μg·kg-1 was injected in group DR and 25 mL of 0.25% ropivacaine was injected in group R. General intravenous anesthesia was provided in all groups during operation. And patient-controlled intravenous analgesia was provided to all the patients postoperatively. Operative time, hemorrhage volume, fluid volume, the dosage of propofol and remifentanil were recorded. The total dosage of sufentanil 24 h after operation and the visual analogue scale(VAS) pain scores at 6, 12, 24, 48 h after operation were recorded. Postoperative delirium was assessed using the Confusion Assessment Method within 3 days after operation. The occurrence of adverse reactions was observed and recorded. RESULTS Compared with the group G, the dosage of propofol during operation significantly decreased in the group DR( P < 0.05). Compared with group G and group R, the dosage of remifentanil during operation significantly decreased in the group DR(P < 0.05). Compared with the group G,the consumption of sufentanil significantly decreased 24 h after operation in group DR and group R(P < 0.05),and the VAS scores at 6, 12 h after operation declined significantly in the group DR( P < 0.05). The VAS score at 6 h after operation was significantly lower in t
作者
朱曼华
裴晴晴
漆勇
何慧娟
梅雨柳
ZHU Man-hua;PEI Qing-qing;QI Yong;HE Hui-juan;MEI Yu-liu(Department of A nesthesiology, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical University Ningbo Medical Center, Ningbo ZHEJIA NG 315040, China;Department of A nesthesiology, Beilun People’s Hospital, Ningbo ZHEJIANG 315800, China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2019年第7期417-421,共5页
Chinese Journal of New Drugs and Clinical Remedies
基金
浙江省医药卫生科技计划项目(2018235388)
关键词
右美托咪定
老年人
谵妄
腹腔镜胃癌根治术
腹横肌平面阻滞
dexmedetomidine
aged
delirium
laparoscopic radical gastrectomy
transversus abdominis plane block
