摘要
目的探究超声引导腹横肌平面(TAP)阻滞联合右美托咪定(DEX)混合罗哌卡因在老年患者腹外疝无张力修补术的麻醉效果。方法选取2017年1月至2019年1月,广东省中山市人民医院收治的腹外疝无张力修补术患者100例,根据麻醉方式不同分为对照组和试验组,每组50例。对照组行常规椎管内麻醉;试验组行TAP联合0.75%罗哌卡因20 ml+右美托咪定20μg+生理盐水20 ml麻醉。术后持续监测患者脉搏、血压、心电图及疼痛视觉模拟评分(VAS)。结果各组间血流动力学指标无明显差异(P>0.05)。4~12 h内试验组患者VAS评分明显低于对照组(P<0.05),12~24 h内试验组患者VAS评分明显低于对照组(P<0.05)。试验组出现尿潴留3例(6%),对照组11例(22%),差异有统计学意义(P<0.05);试验组出现恶心呕吐3例(6%),对照组4例(8%),差异无统计学意义(P>0.05)。结论试验组患者出现不良反应较少,提高围术期患者满意度和降低心脑血管意外发生率。因此超声引导腹横肌平面阻滞罗哌卡因复合右美托咪定在老年患者腹外疝无张力修补术中的应用效果良好,值得在临床上广泛应用。
Objective To explore the anesthetic effect of transversus abdominis plane(TAP) block guided by ultrasound combined with dexmedetomidine(DEX) and ropivacaine in the treatment of tension-free repairing for abdominal external hernia in elderly patients.Methods From January 2017 to January 2019, 100 patients with abdominal external hernia undergoing tension-free repair were randomly divided into control and experimental groups, each with 50 cases in each group.Routine anesthesia was performed in the control group, while the experimental group received TAP with 0.75% ropivacaine 20 ml+ dexmedetomidine 20 μg+ saline 20 ml for anesthesia.The pulse, blood pressure, electrocardiogram, and VAS pain score were continuously monitored after operation.Results There was no significant difference in hemodynamic indexes between the groups(P>0.05).The VAS score at 4-12 h of the experimental group was significantly lower than that of the control group(P<0.05).The VAS score at 12-24 h of the experimental group was significantly lower than that of the control group(P<0.05).3 cases of urinary retention occurred in the test group(6%), and 11 cases in the control group(22%), the difference was statistically significant(P<0.05);There were 3 cases(6%) of nausea and vomiting in the experimental group, and 4(8%) in the control group, with no statistical significance(P>0.05).Conclusion In the experimental group, there were fewer adverse reactions, which were helpful to improves the satisfaction of the patients and reduce the incidence of cardiovascular and cerebrovascular accidents.Therefore, ultrasound-guided TAP block combined with dexmedetomidine and ropivacaine has a good effect in tension-free repair of abdominal external hernia in elderly patients, and it is worthy of wide clinical application.
作者
苏圣贤
解小丽
林志光
杨源锋
Su Shengxian;Xie Xiaoli;Lin Zhiguang;Yang Yuanfeng(Department of Pain Management,Zhongshan City People's Hospital,Zhongshan,Guangdong,528403)
出处
《中华疝和腹壁外科杂志（电子版）》
2020年第6期697-700,共4页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
2014年中山市科技局科研课题(2014A1FC071)。
关键词
疝修补术
超声引导腹横肌平面阻滞
右美托咪定
罗哌卡因
麻醉效果
Herniorrhaphy
Ultrasound-guided transversus abdominis plane block
Dexmedetomidine
Ropivacaine
Anesthetic effect
