超声引导TAP阻滞联合右美托咪定对TURBT术后膀胱刺激征的影响

The Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Dexmedetomidine on Bladder Irritation Symptoms after Transurethral Resection of Bladder Tumor

摘要: 目的：探讨应用右美托咪定联合罗哌卡因行双侧腹横肌平面(TAP)阻滞后入路对经尿道膀胱肿瘤切除术(TURBT)患者术后疼痛和导管相关性膀胱不适(CRBD)的预防效果及安全性。方法：本研究的参与者选择于2024年8月至2025年8月期间在全身麻醉下进行TURBT治疗膀胱肿瘤的患者100例。采用随机对照前瞻性研究，将患者分为两组。A组给予超声引导双侧TAP (每侧0.33%罗哌卡因20 ml) (对照组，n = 50)，B组超声引导双侧TAP (每侧0.33%罗哌卡因20 ml + 25 ug右美托咪定) (干预组，n = 50)。采用CRBD评定量表，在麻醉苏醒时、术后1小时、术后2小时、术后6小时、术后12小时、术后24小时进行询问评分并记录。次要指标包括记录患者术中其他全身麻醉药物的使用量，术中的平均动脉压、心率和血氧饱和度，以及术后并发症(阻滞部位、腹腔内脏器损伤、术后恶心呕吐发生情况、心动过缓等)。结果：B组患者的CRBD评分在麻醉苏醒时、术后1小时、术后2小时、术后6小时显著低于A组(p < 0.001)。术后12小时、术后24小时A组与B组CRBD评分比较无差异(p > 0.05)。两组患者全身麻醉药物中丙泊酚及罗库溴铵的使用量比较无差异(p > 0.05)，舒芬太尼及瑞芬太尼使用量比较差异有统计学意义(p < 0.05)。不同时间点心率、平均动脉压和血氧饱和度比较无差异(p > 0.05)。2组药物相关并发症较少，仅B组有2例心动过缓发生，未见严重TAP及术后相关并发症。结论：在超声引导下进行TAP阻滞时，将右美托咪定作为佐剂与罗哌卡因联用，能安全、有效地减轻TURBT术后CRBD的严重程度，是一种值得推广的优化术后镇痛策略。

Abstract: Objective: To investigate the efficacy and safety of bilateral posterior transversus abdominis plane (TAP) block using dexmedetomidine combined with ropivacaine in preventing postoperative pain and catheter-related bladder discomfort (CRBD) in patients undergoing transurethral resection of bladder tumor (TURBT). Methods: This prospective, randomized controlled trial enrolled 100 patients scheduled for TURBT under general anesthesia between August 2024 and August 2025. Patients were randomized into two groups: Group A (control group, n = 50) received ultrasound-guided bilateral TAP block with 20 mL of 0.33% ropivacaine per side; Group B (intervention group, n = 50) received ultrasound-guided bilateral TAP block with 20 mL of 0.33% ropivacaine plus 25 µg dexmedetomidine per side. The CRBD rating scale was used to assess and record scores at the following time points: upon emergence from anesthesia, and at 1 hour, 2 hours, 6 hours, 12 hours, and 24 hours postoperatively. Secondary outcomes included the cumulative intraoperative dosage of other general anesthetic agents used, as well as intraoperative mean arterial pressure, heart rate, and oxygen saturation. Postoperative complications were also documented, such as issues at the block site, intra-abdominal organ injury, postoperative nausea and vomiting (PONV), and bradycardia, among others. Results: The CRBD scores of patients in Group B were significantly lower than those in Group A at 0 - 12 hours (p < 0.001). No significant difference was observed between Group A and Group B in CRBD scores during the 12 - 24 hours postoperative period (p > 0.05). There was no statistically significant difference between the two groups in the consumption of propofol and rocuronium among general anesthetics (p > 0.05), whereas the consumption of sufentanil and remifentanil showed a statistically significant difference (p < 0.05). No significant differences were found in heart rate, mean arterial pressure, or oxygen saturation at different time points (p > 0.05). Drug‑related complications were infrequent in both groups, with only two cases of bradycardia occurring in Group B. No serious TAP or postoperative complications were observed. Conclusion: The use of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided TAP block is a safe and effective strategy for reducing the severity of postoperative pain and CRBD following TURBT. It represents a recommended and optimized approach for postoperative analgesia.