郭建琰 杨远胡

[摘要]目的探討在腹腔镜结肠癌根治术加速康复外科中应用右美托咪定复合罗哌卡因腹横肌平面阻滞的效果。方法选取2020年1月至2021年1月在惠阳三和医院接受腹腔镜结肠癌根治术治疗的79例患者，采用随机数字表法将其分为两组，观察组（ n=40）术后采用右美托咪定复合罗哌卡因进行腹横肌平面阻滞，对照组（ n=39）则注入同体积生理盐水，比较两组患者在术后各时间点的疼痛程度、镇静效果、恢复情况及不良反应。结果观察组患者在术后6、12、24、48 h 时间点的疼痛程度低于对照组（ P <0.05）;观察组患者在术后6、12、24 h 时间点所获镇静效果优于对照组（ P <0.05）;观察组患者术后首次排气时间、进食时间以及住院时间短于对照组（ P <0.05）;两组患者术后出现不良反应发生率比较，差异无统计学意义（ P >0.05）。结论对接受腹腔镜结肠癌根治术治疗的患者采用右美托咪定复合罗哌卡因行腹横肌平面阻滞可获得较好的效果，能够明显降低疼痛感，提高镇静效果、恢复速度，且不会增加不良反应发生率，符合临床加速康复外科理念。

[关键词]腹腔镜结肠癌根治术;右美托咪定;罗哌卡因;腹横肌平面阻滞

[中图分类号] R614; R735.35  [文献标识码] A   [文章编号]2095-0616（2021）24-0111-04

Evaluation of dexmedetomidine combined with ropivacaine in transversus abdominis plane block in enhanced recovery after surgery after laparoscopic radical colectomy

GUO  Jianyan    YANG  Yuanhu

Department of Anesthesiology， HuiyangSanhe Hospital， Guangdong， Huizhou 516211， China

[Abstract] Objective To explore the effect of dexmedetomidine combined with ropivacaine in transversus abdominis plane block （TAPB） in enhanced recovery after surgery （ERAS） after laparoscopic radical colectomy （LRC）. Methods A total of patients who received LRC in HuiyangSanhe Hospital from January 2020 to January 2021 were selected， and they were randomly divided into two groups. Patients in the observation group（n=40） received dexmedetomidine combined with ropivacaine in TABP after operation， while patients in the control group（n=39） were injected with the same volume of normal saline. The pain degree， sedative effect， recovery and adverse reactions of the two groups were compared at various time points after operation. Results The pain degree of the patients in the observation group was significantly lower than the control group at 6 hours， 12 hours， 24 hours and 48 hours after operation， with statistically significant difference （P <0.05）. The sedation effect in the observation group was significantly better than the control group at 6 hours， 12 hours and 24 hours after operation， with statistically significant difference （P <0.05）. The first exhaust time， eating time and hospitalization time of patients in observation group were significantly shorter than the control group with statistically significant difference （P <0.05）. There was no significant difference in the probability of adverse reactions between the two groups （P >0.05）. Conclusion The application of dexmedetomidine combined with ropivacaine in TAPB can achieve good results for patients undergoing LRC， which can significantly reduce pain， improve sedation and speed up recovery process without increasing the incidence of adverse reactions， which is in line with the concept of ERAS.

[Key words] Laparoscopic radical colectomy; Dexmedetomidine; Ropivacaine; Transverse muscle plane block

结肠癌为临床常见消化道恶性肿瘤，早期患者无明显症状，中晚期患者主要表现为腹胀、消化不良、排便习惯改变等，对其日常生活及生命安全造成严重影响[1]。腹腔镜结肠癌根治术为临床治疗结肠癌疾病首选方案，医师在腹腔镜的辅助下切除病灶，具有创伤小、效果好等优点，但随着术后麻醉效果的消失，患者会感受到剧烈疼痛感，对其术后恢复造成一定影响[2-3]。随着快速康复外科理念的应用与普及，临床提出在术后给予患者使用镇痛、镇静药物以减轻应激反应，缓解疼痛，促进患者术后恢复[4]。……