摘要
目的:分析右美托咪定用于超声引导的腹横肌平面阻滞下行机器人辅助腹腔镜肾盂成形术的肾积水患儿术后疼痛及血流动力学的影响。方法:回顾性分析2023年3月—2024年12月于苏州大学附属儿童医院行机器人辅助腹腔镜肾盂成形术的82例肾积水患儿的病历资料,根据麻醉方案不同分为右美托咪定组(n=43)与非右美托咪定组(n=39)。非右美托咪定组麻醉诱导后采用罗哌卡因,行超声引导下腹横肌平面阻滞,右美托咪定组采用右美托咪定,在超声引导下行腹横肌平面阻滞。对比两组患儿的血流动力学、术后疼痛程度、应激反应、术后镇痛情况及不良反应。结果:麻醉诱导后30 min(T2),两组患儿心率(HR)、平均动脉压(MAP)水平均高于麻醉诱导前(T0),且低于麻醉诱导后5 min(T1)(P<0.05);T1时刻,两组患儿MAP、HR水平均高于T0时刻(P<0.05);T1、T2时刻,右美托咪定组MAP、HR水平低于非右美托咪定组(P<0.05)。两组视觉模拟评分法(VAS)评分在组间、时间、交互方面比较,具有显著差异(P<0.05);两组术后24 h的VAS评分低于术后1 h、术后4 h(P<0.05);术后4 h,两组VAS评分低于术后1 h(P<0.05);右美托咪定组术后1 h、4 h与24 h的VAS评分均低于非右美托咪定组(P<0.05)。术后24 h,两组患儿皮质醇(Cor)以及去甲肾上腺素(NE)水平高于术前,而右美托咪定组比非右美托咪定组更低(P<0.05)。与非右美托咪定组相比,右美托咪定组术后芬太尼消耗量更低(P<0.05),距首次按压镇痛泵时间更长(P<0.05)。两组不良反应发生率对比无显著差异(P>0.05)。结论:右美托咪定用于超声引导下腹横肌平面阻滞可减轻行机器人辅助腹腔镜肾盂成形术的肾积水患儿术后疼痛,维持术中血流动力学稳定,减轻应激反应,强化镇痛效果,且安全性良好。
Objective:To analyze the effect of dexmedetomidine on postoperative pain and hemodynamics in children undergoing robotassisted laparoscopic pyeloplasty for hydronephrosis under ultrasound-guided transversus abdominis plane(TAP)block.Methods:A retrospective analysis was conducted on 82 children with hydronephrosis who underwent robot-assisted laparoscopic pyeloplasty at the Children’s Hospital of Soochow University from March 2023 to December 2024.The patients were divided into the dexmedetomidine group(n=43)and the non-dexmedetomidine group(n=39)based on different anesthesia protocols.The non-dexmedetomidine group received ultrasound-guided TAP block using ropivacaine after anesthesia induction,while the dexmedetomidine group received ultrasound-guided TAP block using dexmedetomidine.Hemodynamics,postoperative pain,stress response,postoperative analgesia,and adverse reactions were compared between the two groups.Results:At 30 minutes after anesthesia induction(T2),the heart rate(HR)and mean arterial pressure(MAP)levels in the two groups were higher than those before anesthesia induction(T0)but lower than those at 5 minutes after anesthesia induction(T1)(P<0.05).At T1,the MAP and HR levels in the two groups were higher than those at T0(P<0.05).At T1 and T2,the MAP and HR levels in the dexmedetomidine group were lower than those in the non-dexmedetomidine group(P<0.05).There were significant differences in the visual analog scale(VAS)scores between the two groups,over time,and in their interaction(P<0.05).The VAS scores at 24 hour after surgery were lower than those at 1 hour and 4 hours after surgery in the two groups(P<0.05).At 4 hours after surgery,the VAS scores in the two groups were lower than those at 1 hour after surgery(P<0.05).The dexmedetomidine group had lower VAS scores at 1 hour,4 hours,and 24 hours after surgery compared to the non-dexmedetomidine group(P<0.05).At 24 hours after surgery,the cortisol(Cor)and norepinephrine(NE)levels in the two groups were higher than those before surgey,but the dexmedetomidine group had lower levels than the non-dexmedetomidine group(P<0.05).Compared to the non-dexmedetomidine group,the dexmedetomidine group had lower postoperative fentanyl consumption(P<0.05)and a longer time to first analgesic pump activation(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided TAP block with dexmedetomidine can reduce postoperative pain,maintain stable intraoperative hemodynamics,alleviate stress response,enhance analgesic effects,and demonstrate good safety in children undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.
作者
谢颖祥
陈霞
仲梦杰
钱望月
袁晴
XIE Yingxiang;CHEN Xia;ZHONG Mengjie;QIAN Wangyue;YUAN Qing(Department of Anesthesiology,Children’s Hospital of Soochow University,Suzhou 215025,China)
出处
《机器人外科学杂志(中英文)》
2025年第12期2054-2059,共6页
Chinese Journal of Robotic Surgery
基金
江苏省自然科学基金面上项目(BK20221172)。
