右美托咪定復合舒芬太尼鎮痛聯合腹橫肌平面阻滯對經腹全子宮全切術患者早期康復的影響

鄒志進　韓曉華

【摘要】 目的：探討右美托咪定復合舒芬太尼鎮痛聯合腹橫肌平面阻滯（TAPB）對經腹全子宮全切術患者早期康復的影響。方法：選擇2017年2月-2019年1月于本院就診并擬行經腹子宮全切術的患者84例，采用隨機數字表法將患者分為研究組與對照組，每組42例。兩組患者均在超聲引導下行TAPB，對照組患者予以舒芬太尼鎮痛，研究組患者予以右美托咪定復合舒芬太尼鎮痛，比較兩組鎮痛效果及早期康復情況。結果：研究組術后2、4、6、12、24、48 h時VAS評分均顯著低于對照組，差異均有統計學意義（P<0.05）。研究組術后24、48、72 h的QOR-15評分均顯著高于對照組，差異均有統計學意義（P<0.05）。研究組的自主呼吸恢復時間、定向力恢復時間、拔管時間、蘇醒室停留時間、首次排氣時間、進食時間、住院時間均顯著短于對照組，差異均有統計學意義（P<0.05）。結論：右美托咪定復合舒芬太尼鎮痛聯合腹橫肌平面阻滯可有效減輕經腹全子宮全切術患者的術后疼痛程度，提高患者早期恢復質量，效果良好，值得推薦。

【關鍵詞】 經腹全子宮全切術 右美托咪定 舒芬太尼 腹橫肌平面阻滯

Effect of Dexmedetomidine Combined with Sufentanil Analgesia Combined with Transverse Abdominal Plane Block on Early Rehabilitation of Patients Undergoing Total Abdominal Hysterectomy/ZOU Zhijin， HAN Xiaohua. //Medical Innovation of China， 2020， 17（10）： 0-064

[Abstract] Objective： To investigate the effect of Dexmedetomidine combined with Sufentanil analgesia combined with transverse abdominal plane block （TAPB） on the early rehabilitation of patients undergoing total abdominal hysterectomy. Method： A total of 84 patients who were admitted to our hospital from February 2017 to January 2019 and underwent total abdominal hysterectomy were selected. Patients were divided into study group and control group by random number table method， 42 cases in each group. Patients in both groups underwent ultrasound-guided TAPB， patients in the control group were given Sufentanil for analgesia， patients in the study group were given Dexmedetomidine combined with Sufentanil for analgesia. The analgesic effect and early recovery of the two groups were compared. Result： VAS scores in the study group at 2， 4， 6， 12， 24 and 48 h after surgery were significantly lower than those in the control group， the differences were statistically significant （P<0.05）. QOR-15 scores of the study group at 24， 48 and 72 h after surgery were significantly higher than those of the control group， the differences were statistically significant （P<0.05）. The recovery time of spontaneous breathing， recovery time of directional force， extubation time， stay time in awaking room， first exhaust time， feeding time and hospitalization time of the study group were significantly shorter than those of the control group， the differences were statistically significant （P<0.05）. Conclusion： Dexmedetomidine combined with Sufentanil analgesia combined with TAPB can effectively reduce the postoperative pain level of patients undergoing total abdominal hysterectomy， improve the quality of patients early recovery， and the effect is good， worthy of recommendation.

[Key words] Total abdominal hysterectomy Dexmedetomidine Sufentanil Transverse abdominis plane block

First-authors address： Affiliated Hospital of Qingdao University， Qingdao 266555， China

doi：10.3969/j.issn.1674-4985.2020.10.015

經腹全子宮全切術式是治療子宮疾病的常用術式，但該術式創傷大，術后切口疼痛嚴重，影響患者術后早期恢復效果，故在術后進行有效鎮痛十分重要[1]。目前，臨床上比較常用的術后鎮痛藥物為阿片類藥物，但使用劑量過多可能會導致患者出現呼吸抑制以及胃腸道不良反應[2]。研究發現，多種藥物或不同鎮痛方法聯合鎮痛的效果良好，如右美托咪定復合舒芬太尼可提高術后鎮痛效果，腹橫肌平面阻滯（TAPB）是目前術后重要的鎮痛方式之一[3-4]。因此，本研究探討右美托咪定復合舒芬太尼鎮痛聯合TAPB對經腹全子宮全切術患者早期康復的影響，現報道如下。

1 資料與方法

1.1 一般資料 選擇2017年2月-2019年1月于本院就診并擬行經腹子宮全切術的患者84例，納入標準：（1）符合經腹全子宮全切術指征;（2）ASA分級Ⅰ～Ⅱ級;（3）可接受TAPB。排除標準：（1）合并心腦血管疾病者;（2）合并嚴重肝腎疾病者;（3）合并凝血功能障礙者;（4）合并呼吸系統疾病者;（5）合并認知障礙或精神疾病者;（6）藥物過敏者。……