右美托咪定与罗哌卡因联合应用于腹横平面阻滞对腹腔镜手术患者应激反应的影响:随机对照试验
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The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial.
背景与目的
静脉注射右美托咪定可减轻腹腔镜手术患者的应激反应。本研究旨在探讨超声引导下经腹横平面阻滞时在罗哌卡因中加入右美托咪定（高选择性α-2肾上腺素能激动剂）是否能抑制腹腔镜手术中的应激反应，并确定右美托咪定的最佳剂量。
方 法
125名接受腹腔镜妇科手术的患者被纳入这项前瞻性随机双盲研究。接受全身麻醉有四方形腹横肌平面(n = 25)的患者，按照有或没有60ml0.2% 罗哌卡因分组，再分别添加结合低(0.25μg /kg),中等(0.50μg /kg)或高剂量(1.0μg /kg)的右美托咪定。主要的观察结果是手术期间标记的压力水平。
结 果
120名患者完成了研究方案。右美托咪定添加到罗哌卡因用于腹横肌平面阻滞，以剂量依赖性的方式显著降低血清皮质醇、去甲肾上腺素、肾上腺素,白细胞介素- 6的水平和血糖、平均动脉压和心率(P < 0.05),减少了围术期的时间和阿片类药物用量(P < 0.05),但高剂量的右美托咪定比低或中等剂量的右美托咪定引起的心动过缓发病率高(P < 0.05)。
结 论
右美托咪定作为一种添加剂，以0.5μg /kg的最佳剂量加入罗哌卡因，在超声引导下用于腹横平面阻滞，能够抑制腹腔镜妇科手术应激反应，对患者血压和心率的影响也很小。
原始文献摘要
The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol, 2019. 19(1): 181.doi：10.1186/s12871-019-0859-7
Background: Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it.
Methods: One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60ml of 0.2% ropivacaine in combination with low (0.25μg/kg), medium (0.50μg/kg) or high dose (1.0μg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block (n=25). The primary outcomes were stress marker levels during the operation.
Results: One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine,interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P<0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine(P < 0.05).
Conclusion: The addition of DEX as an adjunct at the dose of 0.5μg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王丹阳 陈鹏（吉林大学中日联谊医院麻醉科 ）
编辑：何幼芹 审校：王贵龙