国际麻醉学与复苏杂志   2018, Issue (2): 1-1
    
静脉注射地塞米松对腹横肌平面阻滞用于腹腔镜辅助结直肠癌根治术镇痛作用的影响
毕馨文, 王丽婷, 徐芳芳, 江晓菁1()
1.中国医科大学第一临床学院
Analgesic effects of dexamethasone in transversus abdominis plane block for laparoscopic-assisted radical operation of colorectal cancer
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摘要:

目的 观察静脉注射地塞米松对超声引导下腹横肌平面阻滞(transversus abdominis plane block, TAPB)用于腹腔镜辅助结直肠癌根治术镇痛作用的影响。 方法 90例择期行腹腔镜辅助结直肠癌根治术患者按随机数字表法分为3组:对照组(C组,28例),仅给予常规全身麻醉;TAPB组(T组,31例),于全身麻醉诱导后行超声引导下TAPB;10 mg地塞米松静脉注射联合TAPB组(TD组,31例),于全身麻醉诱导前静脉注射地塞米松10 mg,诱导后以同样方法行TAPB。所有患者术后疼痛数字评分法(numerical rating scale, NRS)评分大于3分时给予哌替啶补救镇痛。记录3组术中瑞芬太尼及七氟醚消耗量,术后2、6、12、24、48 h NRS评分,术后第1次给予哌替啶的时间,哌替啶消耗量,术后恶心呕吐(postoperative nausea and vomiting, PONV)发生率。 结果 与C组比较,T组、TD组术中七氟醚消耗量少,术后第1次给予哌替啶的时间晚,术后48 h内各时点NRS评分低、哌替啶消耗量少,PONV发生率低(P<0.05)。 与T组比较,TD组第1次给予哌替啶的时间晚,术后6、12 h NRS评分低,哌替啶消耗量少(P<0.05)。 结论 静脉注射地塞米松可延长TAPB作用时间,增强阻滞效果,减少阿片类镇痛药消耗量。

关键词: 地塞米松; 腹横肌平面阻滞; 罗哌卡因; 腹腔镜治疗; 结直肠癌
Abstract:

Objective To observe the effects of dexamethasone on ultrasound-guided transversus abdominis plane block (TAPB) for laparoscopic-assisted radical operation of colorectal cancer. Methods Ninety patients scheduled laparoscopic-assisted surgeries for colorectal cancer were randomly divided into 3 groups. Patients in group C only received general anesthesia. Patients in group T were given ultrasound-guided TAPB after the induction of anesthesia. Patients in group TD were administrated with 10 mg dexamethasone intravenously before the induction of anesthesia, and then received TAPB. Pethidine was given when numerical rating scale(NRS) pain score was higher than 3, a sign for the requirement of postoperative rescue-analgesia. In this study, we assessed the total consumption of remifentanil and sevoflurane during operation. NRS pain scores were assessed at 2, 6, 12, 24, 48 h after the operation. The first?蛳time administration and consumption of pethidine were recorded. We also recorded incidence of adverse reactions. Results Compared with group C, the consumption of remifentanil and postoperative NRS pain scores at all time points were significantly less in group T and group TD(P<0.05), the first-time administration of pethidine was delayed and the consumption of pethidine was also less(P<0.05) in group T and TD. Incidence of postoperative nausea and vomiting(PONV) in group T and TD was declined(P<0.05). Compared with group T, group TD had lower NRS scores at 6, 12 h after the operation, delayed first-time administration of pethidine, and less consumption of pethidine(P<0.05). Conclusions TAPB combined with dexamethasone intravenously will prolong the time of blockade. Reduction of the total consumption of opioids in laparoscopic-assisted surgery for colorectal cancer was also significant.

Key words: Dexamethasone; Transversus abdominis plane block; Ropivacaine; Therapeutic laparoscope; Colorectal cancer