腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究

发布时间：2018-06-24 07:32

本文选题：腹横肌平面阻滞 + 罗哌卡因　；参考：《第三军医大学学报》2017年07期

【摘要】：目的对比不同浓度的罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者术后的镇痛效应、整体转归和不良反应。方法选择兰州大学第二医院2015年11月至2016年5月择期行LC的60例患者,采用随机数字表法分为0.250%、0.375%浓度罗哌卡因组,每组30例。两组患者均接受全凭静脉麻醉和靶控输注(target controlled infusion,TCI)下诱导和术中维持。手术开始前,实施双侧超声引导的TAP阻滞;手术结束前给予舒芬太尼维持镇痛,转运至麻醉后恢复室和病房后,患者有疼痛主诉时给予帕瑞昔布钠和舒芬太尼镇痛。分别记录术后首次使用额外镇痛药的时间、围术期阿片类药物和帕瑞昔布钠使用总量、术后不同时段的疼痛数字评分(numeric rating scale,NRS)以及相关的不良反应。结果 LC术后两组接受不同浓度的罗哌卡因行TAP阻滞的患者术中瑞芬太尼使用量比较,差异有统计学意义(P0.05),术后镇痛药用量、各时间点疼痛评分和相关的不良反应比较,差异没有统计学意义(P0.05)。结论低浓度罗哌卡因与高浓度相比镇痛效果相当,建议降低浓度以提高TAP阻滞的安全性。
[Abstract]:Objective to compare the analgesic effect, overall outcome and adverse reaction of ropivacaine (transversus abdominis planetotap block in patients with laparoscopic cholecystectomy (LC). Methods 60 patients with LC from November 2015 to May 2016 in the second Hospital of Lanzhou University were randomly divided into 0.250 and 0.375% ropivacaine group with 30 cases in each group. Both groups received induction and intraoperative maintenance under total intravenous anesthesia and target-controlled infusion of (target controlled. Before operation, bilateral ultrasound guided tap block was performed, and sufentanil was administered to maintain analgesia before operation, and to be transferred to the recovery room and ward after anesthesia, the patients were given pareoxib sodium and sufentanil for analgesia when they had the main complaint of pain. The time of initial use of additional painkillers, the total amount of opioid and paroxib sodium used during perioperative period, the pain number score (numeric rating scale NRS) and the related adverse reactions were recorded respectively. Results there were significant differences in remifentanil usage between two groups of patients who received different concentrations of ropivacaine during tap block after LC (P0.05). The dosage of analgesics, pain score and related adverse reactions at different time points were compared between the two groups (P0.05). The difference was not statistically significant (P0.05). Conclusion the analgesic effect of low concentration ropivacaine is comparable to that of high concentration. It is suggested that the safety of tap block be improved by reducing the concentration of ropivacaine.
【作者单位】：兰州大学第二医院麻醉科;康县第一人民医院消毒供应室;
【分类号】：R614.4

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