Intravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial
Intravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial
复制标题
静脉注射右美托咪定联合超声引导直肌鞘阻滞用于开腹胃切除术：一项前瞻性随机试验
DOI：
10.1007/s11605-019-04249-2
复制
发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Yuan, Hongbin
中科院分区：
文献类型：
--
作者：
Li, Yonghua;Jiang, Xin;Yuan, Hongbin
目的比较右美托咪定静脉滴注与腹直肌鞘阻滞对腹部探查术中血流动力学阳性反应（HR > 100 beats min（-1）或SBP > 160 mmHg）及术后中度疼痛的发生率。方法将100例开腹胃切除术患者随机分为两组，每组100例（组B，n = 25），初始负荷剂量为0.6 μ g kg（-1）右美托咪定，随后在整个手术过程中持续输注0.2 μ g kg（-1）h（-1 D组（n = 25）、腹直肌鞘阻滞+右美托咪定组（BD组，n = 25）、腹直肌鞘阻滞+右美托咪定组（C组，n = 25）。全身麻醉技术标准化。记录腹膜切口（T-PI）、腹部探查开始后5 min（TAE-5）、10 min（TAE-10）和15 min（TAE-15）时的HR、SBP和阳性血流动力学反应，以及术后中度疼痛的发生率。结果腹部探查时血流动力学阳性反应B组（82%）和C组（74%）明显高于D组（14%）和BD组（9%）（P均= 0.000）。D组和BD组HR和SBP低于C组和B组（P均< 0.05）。与T-PI相比，B和C组在腹部探查期间HR和SBP显著增加（均P < 0.05）（，），而BD组无此变化（TAE-15时HR除外）。术后1、2、6 h，B组和BD组中度疼痛发生率明显低于C组和D组（P均< 0.0083）。结论右美托咪定静脉输注联合腹直肌鞘阻滞可提高腹部探查术中血流动力学的稳定性，改善术后镇痛效果。
Purpose To compare the incidences of positive hemodynamic response (HR > 100 beats min(-1) or SBP > 160 mmHg) during abdominal exploration and moderate pain after surgery, when using dexmedetomidine infusion and rectus sheath block. Methods One hundred patients undergoing open gastrectomy were randomized to receive rectus sheath block with ropivacaine (Group B, n = 25), initial loading dose of 0.6 mu g kg(-1) dexmedetomidine, followed by a continuous infusion of 0.2 mu g kg(-1) h(-1) throughout surgery (Group D, n = 25), both rectus sheath block and dexmedetomidine (Group BD, n = 25), or neither rectus sheath block nor dexmedetomidine (Group C, n = 25). General anesthesia techniques were standardized. HR, SBP, and positive hemodynamic response at peritoneum incision (T-PI), 5 min (TAE-5), 10 min (TAE-10), and 15 min (TAE-15) after the start of abdominal exploration, and incidences of moderate postoperative pain were recorded. Results Positive hemodynamic responses during abdominal exploration were more common in Groups B (82%) and C (74%) than in Groups D (14%) and BD (9%) (all P = 0.000). HR and SBP were lower in Groups D and BD, compared with those in Groups C and B (all P < 0.05). Compared with T-PI, HR and SBP increased significantly in Groups B and C during abdominal exploration (all P < 0.05)(,) but not in Group BD (except HR at TAE-15). The incidences of moderate pain in Groups B and BD were noticeably lower than in Groups C and D at 1 h, 2 h, and 6 h after surgery (all P < 0.0083). Conclusion Dexmedetomidine infusion combined with rectus sheath block provided more hemodynamic stability during abdominal exploration and better analgesia after surgery.