罗哌卡因双侧胸椎旁神经阻滞联合全身麻醉用于非体外循环冠脉搭桥手术20例  

Application of Combined General Anesthesia and Bilateral Thoracic Paravertebral Block by Ropivacaine in 20 Cases of Patients Undergoing Off-pump Coronary Artery Bypass Surgery

作　　者：陈明兵[1] 张毅[1] 金传刚[1] 万里[1] 廖明锋[1] 谭娟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《医药导报》2015年第4期476-479,共4页Herald of Medicine

摘　　要：目的观察全身麻醉(全麻)复合罗哌卡因单次双侧胸椎旁神经阻滞用于非体外循环冠脉搭桥(OPCAB)手术的麻醉效果。方法将40例择期行OPCAB的患者采用随机数字表法随机分为单纯全麻组(A组,n=20)和全麻复合罗哌卡因双侧胸椎旁神经阻滞组(B组,n=20),记录两组患者在术中发生异常血流动力学的频数,以及心血管药物的使用量,并记录术中及术后镇痛舒芬太尼的用量及术后气管导管保留时间和重症监护室(ICU)停留时间。结果 B组有2例因椎旁阻滞效果不符合要求未纳入之后研究;与A组比较,B组术中发生高血压的频数明显减少(P<0.05),而术中尼卡地平的使用量也随之减少(P<0.05),B组患者术中及术后舒芬太尼的用量均明显减少(P<0.01或P<0.05),术后气管导管保留时间及ICU停留时间也缩短(P<0.05)。结论全麻复合罗哌卡因单次双侧椎旁阻滞用于OPCAB手术有利于维持术中循环稳定,减少麻醉镇痛药物用量,并有利于患者术后早期恢复。Objective To investigate the effectiveness of the combination of general anesthesia （ GA） and single-shot bilateral thoracic paravertebral block （ TPVB） by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery （ OPCAB） . Methods Forty patients with coronary heart disease scheduled for elective OPCAB surgery were randomly divided into two groups：general anesthesia group （group A, n=20） and general anesthesia combined with bilateral thoracic paravertebral block group （group B, n=20）. The frequency of hemodynamic abnormalities and dosage of vasoactive drugs during the period of operation were recorded. Meanwhile, other reference data were recorded, such as the consumption of sufentanil during operation and postoperative analgesia, the time of endotracheal tube retention and intensive care unit （ ICU） stay. Results Two cases were excluded from the study in group B for failure block. Compared with group A, the frequency of hypertension and the amount of nicardipine was lower during operation in group B （P〈0. 05）, the consumption of sufentanil was less both during operation （P〈0. 01） and postoperative analgesia （P〈0. 05）. Moreover, the time of tracheal tube retention and ICU stay were shorter in group B （P〈0. 05）. Conclusion The findings of this study indicate that GA combined with single-shot TPVB is superior to GA alone in improving haemodynamic stability in patients undergoing OPCAB surgery. The combination therapy can also reduce the use of opiates and shorten the time of recovery.

关 键 词：罗哌卡因 麻醉 全身 椎旁神经阻滞 胸段 双侧 冠脉搭桥 非体外循环 

分 类 号：R971.2[医药卫生—药品] R541[医药卫生—药学]