右美托咪定椎旁给药辅助镇痛对开胸术后疼痛的影响研究  

Effect of dexmedetomidine paravertebral auxiliary analgesia on post-thoracotomy pain

作　　者：彭捷[1] 吴友平[1] 马家慧 陆建华[1] 周扬[1] 屠伟峰[1] PENG Jie;WU Youping;MA Jiahui;LU Jianhua;ZHOU Yang;TU Weifeng(Department of Anesthesiology,Guangzhou General Hospital of Guangzhou Military Region,Guangzhou,Guangdong 510010,China)

机构地区：[1]广州军区广州总医院麻醉科,广州510010

出　　处：《重庆医学》2018年第25期3288-3291,共4页Chongqing medicine

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;2014A020212410)

摘　　要：目的探讨右美托咪定椎旁给药辅助镇痛对开胸术后急慢性疼痛的影响。方法择期全身麻醉下行开胸肺癌根治术患者60例,分为胸段硬膜外镇痛组(E组)、连续椎旁阻滞镇痛组(T组)、右美托咪定椎旁辅助镇痛组(TD组),每组20例。各组诱导前硬膜外或椎旁分次给予0.35%罗哌卡因0.3mL/kg(总量小于或等于20mL),术后采用连续硬膜外或椎旁阻滞镇痛;TD组诱导前罗哌卡因中含右美托咪定1μg/kg,术后镇痛配方含右美托咪定4μg/kg。必要时静脉给予地佐辛,维持术后48h内疼痛数字评分(NRS)≤3分。记录各组术后48h内PCA按压次数、地佐辛用量,以及围术期低血压、心动过缓、恶心呕吐、眩晕等不良反应发生率。比较各组术后1、3、6个月的NRS及切口慢性疼痛(NRS>3)发生率。结果 TD组患者术后48h内PCA按压次数及地佐辛用量明显少于E组及T组(P<0.05);E组患者围术期低血压及心动过缓发生率明显高于T组与TD组(P<0.05);TD组患者恶心呕吐发生率低于E组及T组(P<0.05)。TD组患者术后3、6个月的NRS及切口慢性疼痛(NRS>3)发生率明显低于E组及T组(P<0.05)。结论右美托咪定椎旁给药辅助镇痛可有效缓解开胸术后急性疼痛,降低开胸术后疼痛综合征发生率,不良反应少。Objective To explore the effect of dexmedetomidine paravertebral auxiliary analgesia for post-thoracotomy acute and chronic pain.Methods Sixty patients undergoing elective thoracotomy radical operation of lung cancer under general anesthesia were selected and randomly divided into three groups:thoracic segment epidural analgesia group(group E),continuous paravertebral analgesia group(group T)and dexmedetomidine paravertebral auxiliary analgesia group(group TD).Each group was given 0.35%ropivacaine 0.3 mL/kg(no mone than 20 mL)through epidural or paravertebral catheter before induction.Continuous epidural or paravertebral block analgesia was postoperatively adopted;in the group TD,ropivacaine was mixed with dexmedetomidine(1μg/kg in paravertebral block before induction and 4μg/kg in postoperative analgesia).In necessity,dezocine was intravenously given in order to mantain NRS≤3 within postoperative 48 h.PCA pressing frequency,dezocine dosage and occurrence rates of adverse reactions such as perioperative hypotension,bradycardia,nausea and vomiting and dizziness were all recorded in each group.The NRS score and occurrence rate of operative incision chronic pain(NRS>3)at postoperative 1,3,6 month were compared among groups.Results The PCA pressing times and dezocine dosage within postoperative 48 h in the group TD were significantly less than those in the group E and T(P<0.05).The incidence rates of perioperative hypotension and bradycardia in the group E were significantly higher than those in the group T and TD(P<0.05).The incidence rate of nausea and vomiting in the group TD was lower than that in the group E and T(P<0.05).The NRS score and occurrence rate of operative incision chronic pain(NRS>3)at postoperative 3,6 month in the group TD were significantly lower than those in the group E and T(P<0.05).Conclusion Dexmedetomidine paravertebral auxiliary analgesia could effectively alleviate the acute pain in thoracotomy and reduces the incidence rate of post-thoracotomy pain syndrome with less adverse reaction

关 键 词：右美托咪定 开胸手术 镇痛 开胸术后疼痛综合征 

分 类 号：R614.4[医药卫生—麻醉学]