2026 年第 10 期 第 21 卷

罗哌卡因复合不同剂量右美托咪定四点神经阻滞对腹腔镜肝肿瘤手术患者术后镇痛效果及安全性的影响

Effects of four-point nerve block with ropivacaine combined with different doses of dexmedetomidine on postoperative analgesia and safety in patients undergoing laparoscopic liver tumor surgery

作者：韦慧君1零丽2伍春兰3戴璐铭1凌国栩1许庆龄1梁印生1孔繁丽4蒋小玲1龚拯1

英文作者：Wei Huijun1 Ling Li2 Wu Chunlan3 Dai Luming1 Ling Guoxu1 Xu Qingling1 Liang Yinsheng1 Kong Fanli4 Jiang Xiaoling1 Gong Zheng1

单位：1广西壮族自治区人民医院麻醉科，南宁530021；2广西壮族自治区工人医院麻醉科，南宁530021；3广西壮族自治区人民医院手术室，南宁530021；4湖北省武汉儿童医院疼痛与睡眠诊疗中心，武汉430014

英文单位：1Department of Anesthesiology the People′s Hospital of Guangxi Zhuang Autonomous Region Nanning 530021 China; 2Department of Anesthesiology Guangxi Zhuang Autonomous Region Workers′ Hospital Nanning 530021 China; 3Operating Room the People′s Hospital of Guangxi Zhuang Autonomous Region Nanning 530021 China; 4Pain and Sleep Diagnosis and Treatment Center Wuhan Children′s Hospital Hubei Province Wuhan 430014 China

关键词：腹腔镜肝肿瘤手术；右美托咪定；罗哌卡因；多模式镇痛

英文关键词：Laparoscopiclivertumorsurgery;Dexmedetomidine;Ropivacaine;Multimodalanalgesia

• 摘要：

• 目的  探讨罗哌卡因复合不同剂量右美托咪定（DEX）四点神经阻滞对腹腔镜肝肿瘤手术患者术后镇痛效果及安全性的影响。方法 纳入2024年12月至2025年7月在广西壮族自治区人民医院接受全身麻醉下腹腔镜肝肿瘤手术患者120例。按随机数字表法分为4组，各30例。对照组采用常规全身麻醉、不实施神经阻滞干预；LD1组、LD2组、LD3组采用全身麻醉联合四点神经阻滞，分别接受0.3%罗哌卡因复合右美托咪定0.1、0.3和0.5 μg/kg干预。因术后有情况复杂者剔除，最终各组分别有29、27、29、27例纳入分析。比较4组患者术后疼痛数字评分表（NRS）和伯格曼舒适度量表（BCS）评分、术后15项恢复质量评分（QoR-15）、手术相关指标及药物的不良反应等。结果 术后72 h对照组、LD1组、LD2组、LD3组静息NRS评分分别为1.0(1.0,1.0)、1.0(1.0,1.0)、1.0(1.0,1.0)、2.0(1.0,2.0)分，LD3组静息、运动NRS评分均高于对照组、LD1组（均P<0.05），但LD2组静息评分低于对照组（P<0.05）。术后24、48、72 h和出院当天，LD2组、LD3组QoR-15均高于LD1组（均P<0.05）。LD1组、LD2组、LD3组瑞芬太尼用量显著少于对照组（均P＜0.05）。4组患者均未发生严重不良反应或并发症。LD2组的恶心（6.9%）、呕吐（6.9%）和头晕（10.3%）发生率在数值上均为各组最低。结论 DEX联合罗哌卡因腹部四点神经阻滞用于腹腔镜肝肿瘤手术，可有效增强术后镇痛效果。DEX 0.3 μg/kg可减少血管活性药物的使用，且未增加不良反应。

• Objective To investigate the effects of four-point nerve block with ropivacaine combined with different doses of dexmedetomidine (DEX) on postoperative analgesia and safety in patients undergoing laparoscopic liver tumor surgery. Methods A total of 120 patients who underwent laparoscopic liver tumor surgery under general anesthesia in the People′s Hospital of Guangxi Zhuang Autonomous Region from December 2024 to July 2025 were enrolled. The patients were divided into four groups by random number table method, with 30 cases in each group. The control group received conventional general anesthesia without nerve block intervention; the LD1, LD2 and LD3 groups received general anesthesia combined with four-point nerve block, and were administered 0.3% ropivacaine combined with dexmedetomidine 0.1, 0.3 and 0.5 μg/kg respectively. Due to the exclusion of patients with complex postoperative conditions, 29, 27, 29, and 27 cases were included in each group for analysis. The numerical rating scale (NRS) for postoperative pain, Bruggemann comfort scale (BCS) scores, 15-item quality of recovery score (QoR-15), surgery-related indicators and adverse drug reactions were compared among the four groups. Results At 72 h after operation, the resting NRS scores of the control group, LD1 group, LD2 group and LD3 group were 1.0(1.0,1.0), 1.0(1.0,1.0), 1.0(1.0,1.0), 2.0(1.0,2.0), respectively. The resting and dynamic NRS scores in the LD3 group were higher than those in the control group and LD1 group (all P<0.05), while the resting score in the LD2 group was lower than that in the control group (P<0.05). At 24 h, 48 h, 72 h after operation and on the day of discharge, QoR-15 scores in the LD2 and LD3 groups were higher than those in the LD1 group (all P<0.05). The consumption of remifentanil in LD1, LD2 and LD3 groups was significantly lower than that in the control group (all P＜0.05). No severe adverse reactions or complications occurred in any of the four groups. The incidences of nausea (6.9%), vomiting (6.9%) and dizziness (10.3%) in the LD2 group were numerically the lowest among all groups. Conclusion Abdominal four-point nerve block with DEX combined with ropivacaine for laparoscopic liver tumor surgery can effectively enhance postoperative analgesia. DEX at 0.3 μg/kg can reduce the use of vasoactive drugs without increasing adverse reactions.