罗哌卡因复合右美托咪定多靶点胸椎旁神经阻滞超前镇痛对肺癌手术术后镇痛的影响  

The effects of ropivacaine combined with dexmedetomidine for target thoracic paravertebral nerve blocks by multiple injections for preemptive analgesia on postoperative analgesia ofpatients of pulmonary cancer undergoing thoracotomy

作　　者：郭芳[1] 王存金[1] 龙丰云[1] 葛亚丽[1] 夏德国[1] 高巨[1] 

机构地区：[1]苏北人民医院麻醉科,江苏扬州225001

出　　处：《中国医师进修杂志》2017年第12期1087-1090,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨罗哌卡因复合右美托咪定多靶点胸椎旁神经阻滞超前镇痛对开胸手术术后镇痛的影响.方法 择期全身麻醉下行单侧开胸手术的患者90例,年龄35~64岁,性别不限,体质量指数（BMI）18~24 kg/m2,美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级.采用随机数字表法将患者分为三组,每组30例：常规全身麻醉组（G组）、罗哌卡因用于胸椎旁神经阻滞组（R组）和右美托咪定混合罗哌卡因用于胸椎旁神经阻滞组（RD组）.三组均采用静脉输注丙泊酚、瑞芬太尼和吸入七氟烷维持麻醉,均于术毕缝皮时行患者自控静脉镇痛（PCIA）,同时R组和RD组麻醉前于超声引导下行患侧T4~T8多点椎旁神经阻滞,R组注射0.5%罗哌卡因19 ml与0.9%氯化钠溶液1 ml的混合液,RD组注射右美托咪定1 μg/kg混合0.5%罗哌卡因19 ml.三组均镇痛至术后48 h,维持视觉模拟量表（VAS）评分〈4分,当VAS评分≥4分时,静脉注射吗啡5~10 mg.记录术中丙泊酚、瑞芬太尼的使用剂量,术后PCIA药液消耗量、吗啡使用情况、嗜睡、恶心呕吐、呼吸抑制、皮肤瘙痒和尿潴留的发生情况;记录胸椎旁神经阻滞有关不良事件的发生情况.结果 R组和RD组术中丙泊酚用量、瑞芬太尼用量显著低于G组[（7.2 ± 0.6）、（6.1 ± 0.5）mg/（kg·h）比（8.1 ± 0.5）mg/（kg·h）],差异有统计学意义（P〈0.05）.RD组术中丙泊酚用量显著低于R组[（6.1 ± 0.5）mg/（kg·h）比（7.2 ± 0.6）mg/（kg·h）],差异有统计学意义（P〈0.05）.与G组比较,R组和RD组术后PCIA药液消耗量减少,吗啡使用率降低,差异均有统计学意义（P〈0.05）,而且RD组药液消耗量、吗啡使用率也低于R组,差异有统计学意义（P〈0.05）.与G组比较,R组和RD组术后恶心呕吐和皮肤瘙痒的发生率降低,差异有统计学意义（P〈0.05）.三组嗜睡发生率比较差异无统计学意义（P〉0.05）.结论 右美托咪定混合罗哌卡因多靶Objective To evaluate the efficacy of dexmedetomidine mixed with ropivacaine for thoracic paravertebral nerve blocks by multiple injections for preemptive analgesia on postoperative analgesia of patients undergoing thoracotomy. Methods Ninety patients, all genders, ASA Ⅰ or Ⅱ, aged 35-64, BMI 18-24 kg/m2, undergoing radical operation for esophageal carcinoma were randomly divided into three groups （each group 30 patients）： group C received general anesthesia, group R received ropivacaine for thoracic paravertebral nerve block and group RD received dexmedetomidine mixed with ropivacaine for thoracic paravertebral nerve block.Three groups all used intravenous infusion of propofol, refentanyl and inhalation sevoflurane for anesthesia maintenance, and PCIA pump started before the end of surgery in 3 groups.Meanwhile, group R and group RD received ultrasound-guided T4-T8thoracic paravertebral nerve blocks by multiple injections on operation side preoperatively.In group R, the mixture of 0.5% ropivacaine 19 ml and 1ml of normal saline was injected, and in group RD, the mixture of dexmedetomidine 1 μg/kg and 19 ml of 0.5% ropivacaine was injected.The analgesia process lasted 48 h after surgery of these 3 groups, and the VAS score was maintained〈4 points.When the VAS score was 4 or more points, intravenous injection of morphine 5- 10 mg was delivered. Postoperative PCIA liquid and morphine consumption, somnolence, nausea, vomiting, respiratory depression, itching and urinary retention was recorded. Additionally, the occurrences of adverse events about thoracic paravertebral nerve blocks were recorded.Results The dosages of propofol, refentanyl in group R and group RD were lower than those in group G：（7.2 ± 0.6）,（6.1 ± 0.5）mg/（kg·h）vs.（8.1 ± 0.5）mg/（kg·h）, and there were significant differences（P〈0.05）.The dosage of propofol in group RD was lower than that in group R： （6.1 ± 0.5） mg/（kg·h） vs. （7.2 ± 0.6） mg/（kg·h）, and there was significant difference �

关 键 词：右美托咪啶 神经传导阻滞 超前镇痛 胸廓切开术 

分 类 号：R614[医药卫生—麻醉学]