罗哌卡因复合右美托咪定竖脊肌平面阻滞对减重手术患者术后胃肠功能恢复的影响

The Effect of Ropivacaine Combined with Dexmedetomidine for Erector Spinae Plane Block on the Postoperative Gastrointestinal Functional Recovery in Patients Undergoing Bariatric Surgery

摘要: 目的：探讨罗哌卡因复合右美托咪定用于竖脊肌平面阻滞对腹腔镜袖状胃切除术患者术后胃肠功能恢复的影响。方法：选取2024年7月至2025年12月期间我院收治的拟行腹腔镜袖状胃切除术的患者90例，采用随机数字表法分为三组：对照组(C组，n = 30)，实验组(E组，n = 30)和实验组(D组，n = 30)。所有患者均接受全身麻醉。术毕前30分钟，C组不进行竖脊肌平面阻滞的全身麻醉，E组行罗哌卡因竖脊肌平面阻滞的全身麻醉(每侧0.33%罗哌卡因20 ml)，D组行罗哌卡因联合右美托咪定竖脊肌平面阻滞的全身麻醉(每侧0.33%罗哌卡因20 ml + 右美托咪定0.5 μg/kg)。记录两组患者T0入室时、T1插管时、T2手术开始后六十分钟时的HR和MAP，术后首次排气时间、首次排便时间、手术后12、24、48小时I-FEED评分情况、术后阿片类药物(如舒芬太尼)累计消耗量、手术后12、24、48小时疼痛数字评分法(VAS)评分。结果：与C组相比，D组和E组术后12 h、24 h、48 h VAS评分均显著降低(P < 0.05)，D组比E组术后12 h、24 h、48 h VAS评分均显著降低(P < 0.05)。与C组相比，D组比E组在术后第一次排气时间，第一次排便时间均显著降低(P < 0.05)。三组患者术后12 h、24 h、48 h的I-FEED评分比较，D组和E组均较C组存在显著降低(P < 0.05)，D组比E组在术后12 h、24 h、48 h的I-FEED评分比较，均显著降低(P < 0.05)。结论：在腹腔镜袖状胃切除术中，应用罗哌卡因复合右美托咪定进行竖脊肌平面阻滞，能有效减轻术后疼痛，减少阿片类药物用量，并通过多机制促进患者术后胃肠功能的早期恢复，缩短住院时间。

Abstract: Objective: This paper aims to investigate the impact of ropivacaine combined with dexmedetomidine for erector spinae plane block on postoperative gastrointestinal functional recovery in patients undergoing laparoscopic sleeve gastrectomy. Methods: A total of 90 patients who were scheduled to undergo laparoscopic sleeve gastrectomy in our hospital from July 2024 to December 2025 were selected. They were randomly divided into three groups using a random number table method: the control group (Group C, n = 30), experimental group E (Group E, n = 30), and experimental group D (Group D, n = 30). All patients received general anesthesia. Thirty minutes before the end of the operation, patients in Group C underwent general anesthesia without erector spinae plane block; patients in Group E received general anesthesia with ropivacaine erector spinae plane block (20 ml of 0.33% ropivacaine on each side); and patients in Group D received general anesthesia with ropivacaine combined with dexmedetomidine erector spinae plane block (20 ml of 0.33% ropivacaine + 0.5 μg/kg dexmedetomidine on each side). Heart rate (HR) and mean arterial pressure (MAP) were recorded at the following time points: T0 (upon entering the operating room), T1 (during intubation), and T2 (60 minutes after the start of the operation). Other recorded data included the time to first flatus, time to first defecation, I-FEED scores at 12, 24, and 48 hours postoperatively, cumulative postoperative opioid (such as sufentanil) consumption, and pain scores using the visual analogue scale (VAS) at 12, 24, and 48 hours postoperatively. Results: Compared with Group C, the VAS scores at 12, 24, and 48 hours postoperatively were significantly lower in both Group D and Group E (P < 0.05). Moreover, Group D had significantly lower VAS scores at 12, 24, and 48 hours postoperatively compared with Group E (P < 0.05). Compared with Group C, Group D and Group E had significantly shorter times to first flatus and first defecation postoperatively (P < 0.05). Regarding the I-FEED scores at 12, 24, and 48 hours postoperatively, both Group D and Group E showed significant reductions compared with Group C (P < 0.05). Additionally, Group D had significantly lower I-FEED scores at 12, 24, and 48 hours postoperatively compared with Group E (P < 0.05). Conclusion: In laparoscopic sleeve gastrectomy, the application of ropivacaine combined with dexmedetomidine for erector spinae plane block can effectively alleviate postoperative pain, reduce opioid consumption, and promote early recovery of postoperative gastrointestinal function through multiple mechanisms, thereby shortening the hospital stay.