右美托咪定复合胸椎旁神经阻滞对患者胸腔镜肺叶切除术后镇痛效果、呼吸功能及认知功能的影响  

Effects of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block on Postoperative Analgesia, Respiratory Function and Cognitive Function in Patients with Thoracoscopic Lobectomy

作　　者：黄润成 谢海辉[1] 张曙[1] HUANG Runcheng;XIE Haihui;ZHANG Shu(Dept.of Anesthesiology,Dongguan People’s Hospital,Guangdong Dongguan 523900,China)

机构地区：[1]东莞市人民医院麻醉科

出　　处：《中国医院用药评价与分析》2019年第11期1339-1341,1346,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2017年东莞市社会科技发展(重点)医学科研项目(No.201750725001112)

摘　　要：目的:探讨右美托咪定复合胸椎旁神经阻滞对患者胸腔镜肺叶切除术后镇痛效果、呼吸功能及认知功能的影响。方法:选取2017年3月至2018年8月东莞市人民医院收治的拟行肺叶切除术的患者114例,按随机数字法均分为对照组和观察组,每组57例。观察组患者给予右美托咪定,以0.8μg/(kg·h)静脉泵注10 min后,以0.3μg/(kg·h)恒速泵注至手术结束的前30 min;对照组患者给予等量0.9%氯化钠注射液。观察两组患者术后简易精神状态检查量表(mini-mental state examination,MMSE)评分,于麻醉前即刻(T0)、插管后(T1)、切皮后15 min(T2)及拔管后30 min(T3)时检测呼吸功能指标和血流动力学指标[平均动脉压(MAP)、心率(HR)]水平,计算氧合指数(OI)、肺泡动脉氧压差(PA-aO2)及呼吸指数(RI),比较两组患者术后视觉模拟评分(visual analogue scale,VAS)、Ramsay评分的差异。结果:术后7 d,两组患者的MMSE评分明显低于术前1 d,但观察组患者明显高于对照组,差异均有统计学意义(P<0.05)。T2-T3时,观察组患者的OI水平明显高于对照组;T2时,观察组患者的RI和PA-aO2水平明显低于对照组,差异均有统计学意义(P<0.05)。T1-T3时,观察组患者的HR水平明显低于对照组;T1-T2时,观察组患者MAP水平明显低于对照组,差异均有统计学意义(P<0.05)。术后12 h,观察组患者的VAS评分明显低于对照组,差异有统计学意义(P<0.05);其他时间点两组患者VAS评分的差异均无统计学意义(P>0.05)。拔除气管导管后5、30及60 min,观察组患者的Ramsay评分明显高于对照组,差异均有统计学意义(P<0.05)。结论:右美托咪定复合胸椎旁神经阻滞能提高肺叶切除术后镇痛效果,对患者术后的呼吸功能及神经功能具有保护作用。OBJECITVE: To investigate the effects of dexmedetomidine combined with thoracic paravertebral nerve block on postoperative analgesia, respiratory function and cognitive function in patients with thoracoscopic lobectomy. METHODS: Totally 114 patients undergoing thoracoscopic lobectomy in Dongguan People’s Hospital from Mar. 2017 to Aug. 2018 were extracted to be divided into the control group and the observation group via the random number table, with 57 cases in each group. The observation group was given dexmedetomidine by intravenous pump at 0.8 μg/(kg·h) for 10 minutes and then 0.3 μg/(kg·h) at a constant rate of intravenous pump until the 30 minutes before the end of the operation, he control group was given the same amount of equivalent 0.9% sodium chloride injection. Mini-mental state examination(MMSE) score, respiratory function indexes and hemodynamic indexes [average arterial pressure(MAP) and heart rate(HR)] were detected immediately before anesthesia(T0), after intubation(T1), 15 min after skin incisions(T2) and 30 min after extubation(T3) of two groups were observed, and oxygenation index(OI), alveolar arterial oxygen pressure difference(PA-aO2) and respiratory index(RI) were calculated, the differences in postoperative visual analogue scale(VAS) and Ramsay scores were compared. RESULS: After treatment of 7 d, the MMSE scale score of two groups was significantly lower than that in the 1 st day before surgery, but the observation group was significantly higher than the control group, with statistically significant differences(P<0.05). At T2-T3, the OI levels in the observation group were significantly higher than those in the control group;at T2, the levels of RI and PA-aO2 in the observation group were significantly lower than those in the control group(P<0.05). At T1-T3, the HR level of the observation group was significantly lower than that of the control group;at T1-T2, the MAP level of the observation group was significantly lower than that of the control group, and the difference was statis

关 键 词：右美托咪定 胸椎旁神经阻滞 镇痛疗效 呼吸功能 认知功能 

分 类 号：R971[医药卫生—药品]