不同剂量右美托咪定混合罗哌卡因椎旁阻滞在开胸术后的镇痛效果  

Analgesic effects of different doses of dexmedetomidine with ropivacaine used in paravertebral block for postoperative pain after thoracotomy

作　　者：彭捷[1] 贾济[1] 吴友平[1] 陆建华[1] 郄文斌[1] 屠伟峰[1] 

机构地区：[1]广州军区广州总医院麻醉科,广东广州510010

出　　处：《中国新药与临床杂志》2017年第2期101-104,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：广东省药学会临床用药研究基金(2015ZT07);广东省科技计划项目(2014A020212554);全军医学科研十二五重点项目(BWS11J016)

摘　　要：目的探讨不同剂量右美托咪定混合罗哌卡因椎旁阻滞在开胸手术后的镇痛效果。方法择期全麻下行开胸肺癌根治术患者60例,随机分为四组,每组15例。对照组诱导前椎旁给药及术后镇痛仅用罗哌卡因。右美托咪定剂量1组(Dex1组)、右美托咪定剂量2组(Dex2组)、右美托咪定剂量3组(Dex3组)诱导前椎旁给予0.35%罗哌卡因0.3 mL·kg^(-1)和右美托咪定1μg·kg^(-1),术后椎旁患者自控镇痛(PCA)使用0.2%罗哌卡因和右美托咪定1、2、4μg·kg^(-1)。必要时静脉给予地佐辛,维持术后48 h内疼痛视觉模拟量表(VAS)评分≤3分。记录各组阻滞后30 min,术后24 h,PCA结束后12、24 h的感觉阻滞节段数;术后48 h内PCA按压次数及地佐辛用量。比较各组围术期不良反应发生情况。结果阻滞后30 min及术后24 h Dex1组、Dex2组、Dex3组感觉阻滞节段数多于对照组(P<0.05);PCA结束后12、24 h,Dex2组与Dex3组感觉阻滞节段数多于Dex1组及对照组(P<0.05)。Dex2组与Dex3组术后PCA按压次数及地佐辛用量少于Dex1组及对照组(P<0.05)。Dex2组与Dex3组各时点感觉阻滞节段数、术后PCA按压次数及地佐辛用量无显著差异(P>0.05)。Dex3组心动过缓、嗜睡发生率高于其他三组(P<0.05)。结论右美托咪定混合罗哌卡因椎旁阻滞用于开胸术后镇痛可增加阻滞范围,增强镇痛效果,其中右美托咪定2μg·kg^(-1)混合罗哌卡因术后持续镇痛,效果良好,不良反应较少。AIM To explore the effects of different doses of dexmedetomidine（ Dex） with ropivacaine used in paravertebral block for postoperative pain after thoracotomy. METHODS Sixty patients undergoing thoracotomy were randomly divided into four groups including 15 patients in each. Control group（ group C）received ropivacaine only in pre- induction paravertebral block and postoperative analgesia. Group Dex1, Dex2 and Dex3 received Dex 1 μg·kg^-1 with 0.35% ropivacaine 0.3 m L·kg^-1 in pre- induction paravertebral block,and Dex 1, 2, 4 μg ·kg^-1 with 0.2% ropivacaine in paravertebral patient controlled analgesia（PCA）respectively after operation. Dezocine could be used in order to maintain VAS scores ≤ 3 in 48 h after operation.The segments of blocks were recorded at 30 min after block, 24 h after operation, 12 h after PCA ended and 24 h after PCA ended. Datas of PCA pressing frequencies, dezocine consumptions during 48 h after operation were taken. Incidences of adverse reactions in the four groups were compared. RESULTS The block segments were more in the group Dex1- Dex3 compared with the group C at 30 min after block and 24 h after operation（P〈0.05）. The block segments were more in the group Dex2 and group Dex3 compared with the group Dex1 and group C at 12 h, 24 h after PCA ended（P〈0.05）. The PCA pressing frequencies and dezocine consumptions of the group Dex2 and group Dex3 were less than the group Dex1 and group C（ P〈0.05）. There were no significant differences in block segments, PCA pressing frequencies and dezocine consumptions between the group Dex2 and group Dex3（ P〉0.05）. The incidences of bradycardia and hypersomnia were higher in the group Dex3 compared with the other three groups（P〈0.05）. CONCLUSION As an adjuvant with ropivacaine in paravertebral block for thoracotomy, Dex can extend block range and enhance the analgesic effects. Among the investigated doses, Dex 2 μg·kg^-1 with ropivacaine showed fine postoperative analgesia with less adverse reactions.

关 键 词：右美托咪定 罗哌卡因 肺外科手术 镇痛 胸椎旁阻滞 

分 类 号：R971[医药卫生—药品]