[1]林晓东 郭雨 李文玲 范春潮 徐刚 陈德兴* ①.羟考酮与右美托咪定复合腰方肌阻滞在腹腔镜直肠癌根治术中的应用[J].中国微创外科杂志,2023,01(11):830-834.
　Lin Xiaodong,Guo Yu,Li Wenling,et al.Application of Oxycodone and Dexmedetomidine Combined With Quadratus Lumborum Block in Laparoscopic Radical Resection of Rectal Cancer[J].Chinese Journal of Minimally Invasive Surgery,2023,01(11):830-834.
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羟考酮与右美托咪定复合腰方肌阻滞在腹腔镜直肠癌根治术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年11期
页码:
830-834
栏目:
临床研究
出版日期:
2023-11-25

文章信息/Info

Title:
Application of Oxycodone and Dexmedetomidine Combined With Quadratus Lumborum Block in Laparoscopic Radical Resection of Rectal Cancer
作者:
林晓东 郭雨 李文玲 范春潮 徐刚 陈德兴* ①
(吉林省前卫医院麻醉科，长春130012)
Author(s):
Lin Xiaodong;  Guo Yu;  Li Wenling;  et al.
Department of Anesthesiology, Jilin Province Qianwei Hospital, Changchun 130012, China
关键词:
羟考酮; 右美托咪定; 腰方肌阻滞; 腹腔镜手术; 直肠癌
Keywords:
Oxycodone; Dexmedetomidine; Quadratus lumborum block; Laparoscopic surgery; Rectal cancer
文献标志码:
A
摘要:
目的探讨羟考酮与右美托咪定复合腰方肌阻滞(quadratus lumborum block，QLB)在腹腔镜直肠癌根治术中的应用。方法回顾性分析2020年1月~2022年12月全身麻醉下腹腔镜直肠癌根治术50例资料，根据麻醉医生是否掌握QLB技术分为2组，25例采用芬太尼族镇痛的全身麻醉(对照组)，25例采用羟考酮与右美托咪定复合超声引导下QLB镇痛的全身麻醉(观察组)。比较2组进入手术室(T0)、麻醉诱导结束后气管插管前(T1)、建立人工气腹后(T2)、结-直肠端端吻合(T3)、手术结束后(T4)平均动脉压(MAP)，心率(HR)；围麻醉期不良事件；术中出血量、手术时间以及术后恢复情况。结果观察组T1时MAP下降幅度低于对照组(P<0.05)，T2时MAP升高幅度低于对照组(P<0.05),T2、T3时HR升高幅度低于对照组(P<0.05)。观察组麻醉不良事件如苏醒延迟(0例vs. 10例，P=0.030)、苏醒期躁动(0例vs. 12例，P=0000)、呼吸遗忘(0例vs. 12例，P=0.000)、恶心呕吐(3例vs.15例， χ2=12.500，P=0.000)较对照组少，2组氧合指数低于300 mm Hg和延迟拔管发生率差异无显著性(均P=0.050)。2组手术时间和出血量无显著差异(P>0.05)，观察组下地活动时间和排气时间与对照组比较更早(P<0.05)。结论羟考酮与右美托咪定复合QLB镇痛的全身麻醉可安全地用于腹腔镜直肠癌根治术，优于用芬太尼族镇痛的全身麻醉。
Abstract:
ObjectiveTo investigate the application of oxycodone and dexmedetomidine combined with quadratus lumborum block (QLB) in laparoscopic radical resection of rectal cancer.MethodsClinical data of 50 cases of laparoscopic radical resection of rectal cancer under general anesthesia from January 2020 to December 2022 were retrospectively analyzed. They were divided into 2 groups according to whether anesthesiologists had mastered QLB technology. The control group included 25 cases who were given general anesthesia with fentanyl analgesia, whereas the observation group included the other 25 patients who were given general anesthesia of oxycodone and dexmedetomidine combined with QLB analgesia under ultrasound guidance. The mean arterial pressure (MAP) and heart rate (HR) at the time points of after entering the operating room (T0), before tracheal intubation and after anesthesia induction (T1), after artificial pneumoperitoneum (T2), at endtoend anastomosis (T3), and after surgery (T4), adverse events during the perioperative anesthesia period, intraoperative bleeding volume, operation time, and postoperative recovery were compared between the two groups. ResultsAt T1, the decrease of MAP in the observation group was lower than that in the control group (P<0.05). At T2, the increase of MAP in the observation group was lower than that in the control group (P<0.05). At T2 and T3, the increases of HR in the observation group were lower than those in the control group (P<0.05). As compared to the control group, the observation group had less adverse events during the perioperative anesthesia period, such as delayed recovery (0 case vs. 10 cases, P=0.030), restlessness during recovery (0 case vs. 12 cases, P=0.000), respiratory amnesia (0 case vs. 12 cases, P=0.000), nausea and vomiting (3 cases vs. 15 cases, χ2=12.500, P=0.000). There was no significant difference in the incidence of oxygenation index less than 300 mm Hg and delayed extubation between the two groups (both P=0.050). There were no significant differences in operation time and blood loss between the two groups (P>0.05). The observation group had earlier offbed activity time and exhaust time as compared to the control group (P<0.05).ConclusionGeneral anesthesia of oxycodone and dexmedetomidine combined with QLB analgesia can be safely used in laparoscopic radical resection of rectal cancer, which is superior to general anesthesia with fentanyl analgesia.

参考文献/References:

[1]宋玉成，沈霖云，林小宁，等.两孔法腹腔镜Ⅰ、Ⅱ期中高位直肠癌根治术的初步经验.中国微创外科杂志,2020,20(6):29-32.
[2]张媛，斯妍娜，吕云落，等.超声引导下腰方肌阻滞对结直肠癌手术患者术后早期认知功能的影响.临床麻醉学杂志,2019,35(1):19-22.
[3]卢冰.B超引导下腹横神经阻滞对腹腔镜结直肠癌根治术后患者疼痛及免疫反应的影响.腹腔镜外科杂志，2020，25(8)：59-63.
[4]盛芳，李男，谭文斐，等.右美托咪定或地塞米松复合罗哌卡因对椎旁神经阻滞效果的影响.临床麻醉学杂志，2021，37(2)：150-154.
[5]陈孝平，汪建平，赵继宗.外科学．第9版.北京：人民卫生出版社，2018.390-394.
[6]国家卫生健康委员会医政司,中华医学会肿瘤学分会.国家卫生健康委员会中国结直肠癌诊疗规范(2023版).中华胃肠外科杂志,2023,26(6):505-528.
[7]师存霞,张成武,才保加,等.老年结直肠癌患者腹 腔镜根治术围手术期加速康复外科护理标准化工作流程的建立与实施.中华结直肠疾病电子杂志,2020,9(6):636-640.
[8]张晓,余先昊.腹腔镜结直肠癌根治术对老年结直肠癌患者术后胃肠功能恢复的影响.中国老年学杂志,2021,41(11):2283-2286.
[9]中华医学会外科学分会，中华医学会麻醉学分会.中国加速康复外科临床实践指南(2021版).中国实用外科杂志,2021,41(9):961-992.
[10]刘清仁，纪木火，杨建军，等.羟考酮在全身麻醉中的应用进展.药学与临床研究,2021,29(1)：43-46.
[11]曹林,田蜜,张利东，等.盐酸羟考酮注射液在结直肠癌根治术中麻醉及术后镇痛的应用.医学研究生学报,2019,32(12):1296-1300.
[12]高雨婷,张树波,高晓增,等.右美托咪啶与硬膜外阻滞在全麻下老年患者腹腔镜结直肠癌根治术中的应用研究.中国中西医结合外科杂志,2020,26(3):446-451.
[13]杨晓丽，龙飞宇，王茂华，等.腰方肌阻滞与腹横肌平面阻滞对剖宫产术后镇痛效果比较的Meta分析.实用医学杂志，2021，37(5)：611-615.

备注/Memo

备注/Memo:
*通讯作者，Email：jlchendexing@163.com ①普通外科
更新日期/Last Update: 2024-02-06