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[1]林兰英,林献忠,林财珠,等.右美托咪定辅助超声引导腹横肌平面阻滞在老年患者腹股沟斜疝修补术中的应用[J].福建医科大学学报,2016,50(05):325-329.
 LIN Lanying,LIN Xianzhong,LIN Caizhu,et al.Application of Ultrasound-guided Transverses Abdominis Plane Block Assistedwith Dexmedetomidine in the Elderly Patients Undergoing Inguinal Hernia Repair[J].Journal of Fujian Medical University,2016,50(05):325-329.
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右美托咪定辅助超声引导腹横肌平面阻滞在老年患者腹股沟斜疝修补术中的应用(PDF)
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《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第50卷
期数:
2016年05期
页码:
325-329
栏目:
临床研究
出版日期:
2016-10-31

文章信息/Info

Title:
Application of Ultrasound-guided Transverses Abdominis Plane Block Assistedwith Dexmedetomidine in the Elderly Patients Undergoing Inguinal Hernia Repair
文章编号:
1672-4194(2016)05-0325-05
作者:
林兰英 林献忠 林财珠 黄 庆
福建医科大学 附属第一医院麻醉科,福州 350005
Author(s):
LIN Lanying LIN Xianzhong LIN Caizhu HUANG Qing
Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
关键词:
安定镇痛 腹部腹股沟/*外科学 手术后并发症 认知障碍 手术后期间
Keywords:
neuroleptanalgesia abdomen hernia inguinal/*surgery postoperative complications cognition disorders postoperative period
分类号:
R323.3; R614.1
DOI:
-
文献标志码:
A
摘要:
目的探讨右美托咪定(Dex)辅助超声引导下腹横肌平面阻滞应用于老年患者腹股沟斜疝修补术的可行性及其对术后认知功能的影响。 方法 选择拟行单侧腹股沟斜疝修补术的老年男性患者60例,按照随机数字表法随机分为2组,Ⅰ组在超声引导下行腹横肌平面(TAP)阻滞前10 min开始静脉输注Dex 0.5 μg/kg,随后以0.4 μg·kg-1·h-1速度输注,至手术结束前10 min停止,若麻醉效果不佳或麻醉失败,静脉注射芬太尼50~100 μg辅助麻醉或改为喉罩全麻; Ⅱ组采用静吸复合喉罩全麻。2组均采用静脉术后镇痛自控加药(PCA),监测术中生命体征,比较2组在切皮时、手术开始30 min及术毕时的平均动脉压(MAP)和心率(HR),记录2组术后6,12,24和48 h时的疼痛评分和48 h内的PCA次数。2组均于术前、术后2 d采用简易智能状态检查量表(MMSE)进行神经精神功能测试,计算2组发生术后认知功能障碍(POCD)的例数及发生率。 结果 与Ⅱ组比较,Ⅰ组术中HR减慢,但仍在安全范围; 麻醉效果满意27例,阻滞不全3例,未发生TAP阻滞相关并发症。2组术后6,12,24 h的疼痛评分及48 h内的PCA次数差别均有统计学意义(P<0.05); 术后2 d的MMSE评分2组比较差别有统计学意义,且均较术前明显降低; 2组POCD的发生率差别有统计学意义(P<0.05)。 结论 Dex辅助超声引导下TAP阻滞应用于老年患者腹股沟斜疝修补术,操作简单易行,麻醉效果较满意,术后镇痛效果好,可减少老年患者术后POCD的发生率,可作为老年患者腹股沟斜疝修补术的一种新的麻醉方式。
Abstract:
Objective To explore the feasibility of ultrasound-guided transverses abdominis plane block assisted with dexmedetomidine in the elderly patients underwent inguinal hernia repair and the influence on postoperative cognitive function. Methods 60 elderly patients undergoing unilateral inguinal hernia repair were randomly divided into 2 groups. Group Ⅰ was given 0.5 μg/kg dexmedetomidine by intravenous infusion for 10 min before ultrasound guided transverse abdominis plane block implement, followed by 0.4 μg·kg-1·h-1 intravenous infusion until 10 min before the end of operation. If anesthesia effect was not satisfactory or it failed, intravenous fentanyl 50~100 μg assisted anesthesia or general anesthesia with laryngeal mask would be used. Group Ⅱ was given intravenous combined inhalation general anesthesia with laryngeal mask. Postoperatively the patients were given controlled intravenous analgesia in both groups. Vital signs were observed for both groups during the operation. MAP and HR at skin incision, 30 min after incision and the end of operation were measured, and pain scores at 6, 12, 24 and 48 h after operation and the times of PCA during 48 h post-operation were compared between the two groups. All patients took the Mini-Mental State Examination(MMSE)neuropsychological tests before the operation and again two days after the operation. The numbers and the incidence of postoperative cognitive dysfunction(POCD)in both groups were calculated. Results In group Ⅰ HR slowed down during the operation though still in the safe range; anesthesia in 27 cases were satisfactory, while in 3 cases it was an incomplete block. There were no complications related to transverses abdominis plane block. The difference in Pain scores at 6, 12, 24 h after operation, the times of PCA during 48 h after operation and the incidence of POCD between two groups were significant. The difference in the scores of MMSE two days after operation were significant between two groups, and the scores were significantly lower than that before the operation in both groups. Conclusion For the elderly patients undergoing inguinal hernia repair, ultrasound-guided transverses abdominis plane block assisted with dexmedetomidine can provide a new anesthesia choice because of its ease of operation, good anesthesia effect and postoperative analgesia, especially the reduction of the frequency of POCD.

参考文献/References:

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备注/Memo

备注/Memo:
收稿日期: 2016-04-01
基金项目: 福建省卫计委医学创新项目(2015-CX-22); 福建省教育厅一般项目(JA15214)
作者单位: 福建医科大学 附属第一医院麻醉科,福州 350005
作者简介: 林兰英(1979-),女,主治医师,医学硕士
通讯作者: 林献忠. Email: 39162263@163.com
更新日期/Last Update: 2016-10-31