目的:探究右美托咪定联合罗哌卡因腰方肌阻滞对腹腔镜全子宫切除术(LTH)患者镇痛效果和血流动力学影响.方法:选取2021年1月—2023年3月于本院接受全麻下LTH患者72例,信封随机法分为两组各36例,分别给予右美托咪定联合罗哌卡因腰方肌阻滞(联合组)、罗哌卡因腰方肌阻滞(单一组).比较两组术后恢复(苏醒时间、首次排气时间、首次镇痛泵使用时间)及阿片药物用量、镇痛效果[疼痛视觉模拟评分(VAS)量表、Ramsay镇静评分量表]、血流动力学[入室时(T0)、气管插管时(T1)、切皮时(T2)、置入腔镜时(T3)、手术开始时(T4)、手术结束时(T5)和拔管时(T6)的心率(HR)、收缩压(SBP)和平均动脉压(MAP)]和术后不良反应.结果:联合组术后苏醒时间(9.5±0.9 min)和首次排气时间(12.9±1.7 min)均短于单一组(12.9±1.7 min、16.0±2.1 min),首次使用镇痛泵时间(11.87±1.06h)晚于单一组(8.36±0.98h),术后 48 h 舒芬太尼用量(121.83±7.71μg)少于单一组(138.79±8.12μg),术后12 h VAS评分(2.87±0.64分)低于单一组(3.86±0.78分),Ramsay镇静评分(2.99±0.52分)高于单一组(2.53±0.46分),T1～T6时HR、MAP和SBP均低于单一组,术后头晕、恶心等不良反应发生率(8.3％)低于单一组(25.0％)(均P＜0.05).结论:右美托咪定联合罗哌卡因腰方肌阻滞可有效减少LTH患者阿片药物用量、缓解术后镇痛、维持血流动力学稳定和降低不良反应发生率.
Analgesic effect of the quadratus lumborum block by dexmedetomidine combined with ropivacaine during laparoscopic total hysterectomy of patients and its influence on the hemodynamics
Objective:To explore the analgesic effect of the quadratus lumborum block by the dexmedetomidine com-bined with ropivacaine during laparoscopic total hysterectomy(LTH)of patients,and to study its influence on the he-modynamics of the patients.Methods:72 patients who wanted LTH under general anesthesia were selected and were randomly divided into group A(36 cases)and group B(36 cases)by envelope method from January 2021 to March 2023.The patients in group A were given quadratus lumborum block by dexmedetomidine combined with ropivacaine during operation,while the patients in group B were given quadratus lumborum block by ropivacaine.The postopera-tive recovery situation,such as the awakening time,the first exhaust time,the first analgesic pump used time,the opioid dosage,the analgesic effect evaluated by visual analogue scale(VAS)and Ramsay sedation scale scores,the val-ues of hemodynamics,such as heart rate(HR),systolic blood pressure(SBP)and mean arterial pressure(MAP)of the patients at the time of entering the room(T0),tracheal intubation(T1),skin incision(T2),placement of endoscopy(T3),beginning of surgery(T4),end of surgery(T5)and extubation(T6),and postoperative adverse reactions of the patients were compared between the two groups.Results:The postoperative recovery time(9.5±0.9 min)and the first exhaust time(12.9±1.7 min)of the patients in group A were significantly shorter than those(12.9±1.7 min and 16.0±2.1 min)of the patients in group B.The first time of the analgesic pump used(11.87±1.06h)of the patients in group A was significantly later than that(8.36±0.98h)of the patients in group B.The dosage of sufentanil(121.83±7.71μg)of the patients in group A in 48 h after operation was significantly less than that(138.79±8.12μg)of the patients in group B,and the VAS score(2.87±0.64 points)of the patients in group A in 12 h after operation was significantly lower than that(3.86±0.78 points)of the patients in group B.The Ramsay sedation score(2.99±0.52 points)of the patients in group A was significantly higher than that(2.53±0.46 points)of the patients in group B.the values of HR,MAP and SBP of the patients in group A at T1-T6 were significantly lower than those of the patients in group B.The incidence(8.3％)of the adverse reactions,such as dizziness and nausea,of the patients in group A was significantly lower than that(25.0％)of the patients in group B(all P＜0.05).Conclusion:The quadratus lumborum block by dexmedetomidine combined with ropivacaine during LTH of the patients can effectively reduce their opioid dosage,re-lieve their postoperative analgesia,maintain their hemodynamic stability and reduce their incidence of adverse reactions.
Laparoscopic total hysterectomyQuadratus lumborum blockDexmedetomidineRopivacaineAnalgesic effectHemodvnamics
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