2018 年第 6 期 第 13 卷

罗哌卡因复合地塞米松腹横肌平面阻滞对患者妇科腹腔镜术后疼痛与应激反应的影响

Effect of ropivacaine combined with dexamethasone for transversus abdominis plane block on postoperative pain and stress response in patients undergoing gynecological laparoscopic surgery

作者：涂汉坤李朝阳

英文作者：

单位：518052广东省深圳市南山区人民医院麻醉科

英文单位：

关键词：妇科腹腔镜手术；罗哌卡因；地塞米松；腹横肌平面阻滞；术后疼痛；应激反应

英文关键词：

• 摘要：

• 【摘要】目的    观察罗哌卡因复合地塞米松腹横肌平面（TAP）阻滞对患者妇科腹腔镜术后疼痛与应激反应的影响。方法    选择2016年5月至2017年6月于广东省深圳市南山区人民医院住院拟择期于全身麻醉下行妇科腹腔镜手术的80例女性妇科病患者。完全随机分为对照组（C组）和超声引导TAP阻滞组(T组)，各40例。T组患者于超声引导下行双侧TAP阻滞，每侧注射0.25%罗哌卡因+地塞米松5 mg 共30 ml；对照组每侧注射0.9%氯化钠注射液30 ml。采用疼痛视觉模拟量表（VAS）和舒适评分量表（BCS）评分评价患者术后0.5、1、3、6、12、24 h的疼痛程度和满意度。于麻醉前、术后6、12、24 h测定血清C反应蛋白(CRP)和皮质醇水平。记录追加哌替啶及术后不良反应发生情况。 结果T组瑞芬太尼用量明显少于C组，差异有统计学意义（P<0.05）。术后0.5、1、3、6、12、24 h T组VAS评分明显低于C组，BCS评分明显高于C组，差异均有统计学意义(均P<0.05)。T组术后6、12、24 h血清CRP和皮质醇水平均明显低于C组［术后6 h：（0.30±0.09）mg/L比（0.39±0.11）mg/L、（298±32）mg/L比（323±38）mg/L；术后12 h：（0.43±0.12）mg/L比（0.57±0.16）mg/L、（311±41）mg/L比（335±48）mg/L；术后24 h：（0.56±0.18）mg/L比（0.89±0.25）mg/L、（268±34）mg/L比（295±39）mg/L］，差异均有统计学意义(均P<0.05)。2组均无发生躁动、皮肤瘙痒和呼吸抑制，T组术后恶性呕吐、头晕发生率及哌替啶追加率明显低于C组［5.0%（2/40）比12.5%（5/40）、5.0%（2/40）比12.5%（5/40）、5.0%（2/40）比25.0%（10/40）］，差异均有统计学意义(均P<0.05)。结论    对于行妇科腹腔镜手术患者，罗哌卡因复合地塞米松TAP阻滞可有效缓解术后疼痛，减轻应激反应。

• 【Abstract】Objective    To observe the effect of transversus abdominis plane(TAP) block using ropivacaine combined with dexamethasone on postoperative pain and stress response in patients undergoing gynecological laparoscopic surgery. Methods    Eighty patients undergoing gynecological laparoscopic surgery under general anesthesia from May 2016 to June 2017 in Nanshan People′s Hospital of Shenzhen were randomly divided into control group(C group) and ultrasound-guided TAP block group(T group), with 40 cases in each group. Patients in T group had bilateral ultrasound-guided TAP block with 0.25% ropivacaine and dexamethasone 5 mg diluted in sodium chloride solution（30 ml in total） for each side; patients in C group were injected 30 ml sodium chloride solution for each side. Postoperative pain and patient satisfaction were assessed by the Visual Analogue Scale(VAS) and the Bruggrmann Comfort Scale(BCS) at 0.5, 1, 3, 6, 12, 24 h after operation. Levels of serum C-reactive protein(CRP) and cortisol were tested before anesthesia and 6, 12, 24 h after operation. Postoperative usage of pethidine and occurrence of adverse reactions were recorded. Results    Remifentanil dosage in T group was significantly less than that in C group(P<0.05). The VAS score 0.5, 1, 3, 6, 12, 24 h after operation in T group was significantly lower and the BCS score was significantly higher than those in C group(P<0.05). Levels of serum CRP and cortisol 6, 12, 24 h after operation in T group were significantly lower than those in C group［6 h after operation: （0.30±0.09）mg/L vs （0.39±0.11）mg/L, （298±32）mg/L vs （323±38）mg/L; 12 h after operation: （0.43±0.12）mg/L vs （0.57±0.16）mg/L, （311±41）mg/L vs （335±48）mg/L; 24 h after operation:（0.56±0.18）mg/L vs （0.89±0.25）mg/L, （268±34）mg/L vs （295±39）mg/L］(P<0.05). No restlessness, itching or respiratory inhibition occurred. Incidences of postoperative nausea and vomiting, dizziness and use rate of piperidine in T group were significantly lower than those in C group［5.0%（2/40） vs 12.5%（5/40）, 5.0%（2/40） vs 12.5%（5/40）, 5.0%（2/40） vs 25.0%（10/40）］(P<0.05). Conclusion    TAP block using ropivacaine combined with dexamethasone can effectively relieve postoperative pain and decrease stress response in patients with gynecological laparoscopic surgery.