右美托咪定作为佐剂用于肝癌手术患者腹横肌平面阻滞的效果评估

doi:10.3969/j.issn.1009-976X.2020.05.015

摘要/Abstract

摘要： 目的评估右美托咪定作为佐剂用于肝癌手术患者腹横肌平面（TAP）阻滞的临床效果。方法选择择期行开腹肝癌切除术患者60例,根据局麻药液中右美托咪定剂量的大小,随机分为R、D0.5和D1.0三组,每组20例。所有患者均在局麻下行超声引导双侧肋缘下TAP阻滞,R组注入0.5%罗哌卡因40 mL,D0.5组注入等量的局麻药和右美托咪定0.5 μg/kg,D1.0组注入等量的局麻药和右美托咪定1.0 μg/kg。观察TAP阻滞的起效时间、持续时间、患者意识深度（NI）和血流动力学的变化,记录术后苏醒速度、镇痛药用量和并发症的发生情况。结果 R、D0.5、D1.0三组TAP阻滞的起效时间分别为13.1±2.9 min、11.6±2.3 min、7.7±2.1 min,持续时间分别为10.7±3.0 h、13.6±3.1 h、17.3±4.2 h,以上指标组间两两比较有统计学差异（P<0.05）。TAP阻滞后,三组的NI、平均动脉压和心率的变化趋势一致：D1.0组<D0.5组<R组（P<0.05）;但三组的术后苏醒速度无统计学差异。D1.0组术后48小时内的镇痛药用量少于D0.5组和R组（P<0.05）,D0.5组和R组之间无统计学差异。所有患者均未发生TAP阻滞相关并发症。结论右美托咪定与局麻药混合后用于TAP阻滞能加快起效和延长作用时间,同时通过右美托咪定的缓慢吸收入血而发挥镇静和稳定循环的作用。

关键词: 肝癌手术, TAP阻滞, 临床效果, 右美托咪定

Abstract: Objective To evaluate the clinical outcome of TAP block by adding dexmedetomidine as an adjuvant in patients with liver cancer surgery. Methods A total of 60 patients undergoing elective open liver carcinoma resection were enrolled, and were randomly divided into three groups （20 cases in each）, including group R, group D0.5 and group D1.0, according to the dose of dexmedetomidine mixed into local anesthetic solution used for TAP block. All patients underwent bilateral subcostal TAP block under local anesthesia guided by ultrasound. 40 mL 0.5% ropivacaine was injected into the TAP in group R; 40 mL 0.5% ropivacaine mixed with 0.5 μg/kg dexmedetomidine was injected in group D0.5; 40 mL 0.5% ropivacaine mixed with 1.0 μg/kg dexmedetomidine was injected in group D1.0. After TAP block completion, the onset time, duration, Narcotrend Index and hemodynamics were recorded. Recovery time, dosage of analgesic and incidence of complications were compared between groups. Results The onset time of TAP block in group R, group D0.5 and group D1.0 was 13.1±2.9 min,11.6±2.3 min,7.7±2.1 min, respectively, with significant difference between any two groups （P<0.05）. The duration of TAP block in group R, group D0.5 and group D1.0 was 10.7±3.0 h, 13.6±3.1 h,17.3±4.2 h, respectively, with significant difference between any two groups （P<0.05）. Narcotrend Index, arterial pressure and heart rate in group D0.5 or group D1.0 were lower than those of group R （P<0.05）, with those of group D1.0 lower than those of group D0.5 （P<0.05）. The recovery time was not significantly different among the three groups. The dosage of postoperative analgesic within 48 h in group D1.0 was lower than that of group R or group D0.5 （P<0.05）, with no difference between group R and group D0.5. All patients enrolled didn't suffer any complications related to TAP block. Conclusion Mixed with local anesthetic, dexmetomidine can accelerate the onset time and prolong the duration of TAP block, and also play the role of sedation and stabling circulation through it's absorption into blood.

Key words: dexmedetomidine, TAP block, liver cancer surgery, clinical outcome

中图分类号:

R614

黄海明, 陈瑞霞, 袁圆, 叶西就. 右美托咪定作为佐剂用于肝癌手术患者腹横肌平面阻滞的效果评估[J]. 岭南现代临床外科, 2020, 20(05): 614-618.

HUANG Hai-ming, CHEN Rui-xia, YUAN Yuan, YE Xi-jiu. Evaluation of clinical outcome of TAP block by adding dexmedetomidine as an adjuvant in patients with liver cancer surgery[J]. Lingnan Modern Clinics in Surgery, 2020, 20(05): 614-618.

参考文献

[1] Torre LA, Bray F, Siegel RL, et al.Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108.
[2] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[3] 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20.
[4] Feldheiser A, Aziz O, Baldini G, et al.Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice[J]. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
[5] Stoving K, Rothe C, Rosenstock CV, et al.Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers[J]. Reg Anesth Pain Med, 2015, 40(4): 355-362.
[6] 黄海明, 杨雪莹, 罗建伟, 等. 肋缘下腹横肌平面阻滞在开腹肝癌切除术中应用的效果评价[J]. 中山大学学报(医学版), 2019, 40(4): 585-591.
[7] Abdallah FW, Brull R.Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis[J]. Br J Anaesth, 2013, 110(6): 915-925.
[8] Marhofer D, Kettner SC, Marhofer P, et al.Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study[J]. Br J Anaesth, 2013, 110(3): 438-442.
[9] Brummett CM, Amodeo FS, Janda AM, et al.Perineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block[J]. Reg Anesth Pain Med, 2010, 35(5): 427-431.
[10] Brummett CM, Williams BA.Additives to local anesthetics for peripheral nerve blockade[J]. Int Anesthesiol Clin, 2011, 49(4):104-116.
[11] 王承海, 唐晓莉, 尚书军, 等. 肾上腺素对左旋布比卡因臂丛神经阻滞时药代动力学的影响[J].中华麻醉学杂志, 2010, 30(6): 767-768.
[12] 刘月江, 王臻, 景亮. 地塞米松对0.5%罗哌卡因腰丛-坐骨神经联合阻滞作用的影响[J].临床麻醉学杂志, 2010, 26(2): 104-106.
[13] Bailard NS, Ortiz J, Flores RA.Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations[J]. Am J Health Syst Pharm, 2014, 71(5): 373-385.
[14] Rasmussen SB, Saied NN, Bowens CJ, et al.Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis[J]. Pain Med, 2013, 14(8): 1239-1247.
[15] Carroll I, Hah J, Mackey S, et al.Perioperative interventions to reduce chronic postsurgical pain[J]. J Reconstr Microsurg, 2013, 29(4): 213-222.
[16] Qiu H, Sun Z, Shadhiya F, et al.The influence of dexmedetomidine on remifentanil-induced hyperalgesia and the sex differences[J]. Exp Ther Med, 2018, 16(4): 3596-3602.
[17] Rancourt MP, Albert NT, Cote M, et al.Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine[J]. Anesth Analg, 2012, 115(4): 958-962.
[18] Huang Y, Lu Y, Zhang L, et al.Perineural dexmedetomidine attenuates inflammation in rat sciatic nerve via the NF-kappaB pathway[J]. Int J Mol Sci, 2014, 15(3): 4049-4059.