地佐辛复合罗哌卡因胸椎旁神经阻滞在胸科手术中的应用  

Application of dizocine combined with ropivacaine in thoracotomy for thoracic paravertebral nerve block

作　　者：王忠义[1] 苗国瑞 王福朝[1] 张同军[1] 孙学飞[1] 靳红绪[1] 陈金辉[1] WANG Zhongyi;MIAO Guorui;WANG Fuchao(Department of Anesthesia,Harrison International Peace Hospital,Hebei,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院麻醉科,河北省衡水市053000

出　　处：《河北医药》2020年第8期1217-1219,1223,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划项目(编号:20181574)。

摘　　要：目的本研究通过观察地佐辛复合罗哌卡因行胸椎旁神经阻滞,对开胸手术术中及术后镇痛及镇静效果的影响,探讨地佐辛复合罗哌卡因胸椎旁神经阻滞在开胸手术中的应用。方法选择择期行开胸手术肺叶切除患者60例。随机将患者均分为3组:罗哌卡因复合地佐辛组(D组):胸椎旁神经阻滞用药为0.375%罗哌卡因(含地佐辛0.1 mg/kg)0.3 ml/kg;罗哌卡因组(R组):胸椎旁神经阻滞用药为0.375%罗哌卡因0.3 ml/kg;对照组(C组):单纯全麻,不行椎旁神经阻滞。记录3组患者麻醉前,插管后1 min,切皮后5 min,关胸后1 min不同时点的血压(MAP)、心率、氧饱和度(SpO2)及3组患者术后30 min及术后60min时的Ramsay评分和VAS评分及恶心躁动发生例数。结果与单独使用罗哌卡因相比较,地佐辛复合罗哌卡因胸椎旁神经阻滞,术后30 min、60 min患者Ramsay评分优于单独使用罗哌卡因胸椎旁神经阻滞的患者(P<0.05);术后30 min、60 min患者VAS评分,地佐辛复合罗哌卡因胸椎旁神经阻滞的患者VAS评分明显低于单独使用罗哌卡因胸椎旁神经阻滞的患者(P<0.05)。地佐辛复合罗哌卡因胸椎旁神经阻滞的患者与单独使用罗哌卡因胸椎旁神经阻滞的患者术后不良反应发生率差异无统计学意义(P>0.05)。结论地佐辛联合罗哌卡因胸椎旁神经阻滞能为开胸手术提供良好的术中镇痛效果,并能提供较好的术后镇静镇痛效果,且不增加术后不良反应发生率。Objective To investigate the application of dezocine combined with ropivacaine in thoracotomy due to thoracic paravertebral nerve block(TPNB)by observing their effects on the analgesia and sedation during and after thoracotomy.Methods Sixty patients who underwent elective thoracotomy for lobectomy were enrolled in this study.These patients were randomly divided into three groups:ropivacaine combined with dezocine group(group D):0.375%ropivacaine(0.3ml/kg,including 0.1mg/kg dezocine)for thoracic paraspinal nerve block;ropivacaine group(group R):0.375%ropivacaine(0.3ml/kg)for thoracic paravertebral nerve block;the control group(group C):those who underwent general anesthesia alone without paravertebral nerve block.The mean artery pressure(MAP),heart rate,and oxygen saturation(SpO2)of patients in the three groups before anesthesia,1 min after intubation,5min after incision,and 1 min after chest closure were recorded.In addition,the Ramsay score and VAS score at 30min and 60min after surgery as well as the number of cases with nausea and agitation were recorded.Results In terms of thoracic paravertebral nerve block,the Ramsay score in patients who were given dezocine combined with ropivacaine was better at 30min and 60min after surgery than that in patients given ropivacaine alone(P<0.05).At 30min and 60min postoperatively,VAS scores of patients with dezocine combined with ropivacaine were significantly lower than those who were treated with ropivacaine alone for thoracic paravertebral nerve block(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between patients treated with dezocine combined with ropivacaine and those treated with ropivacaine alone for thoracic paravertebral nerve block(P>0.05).Conclusion Dezocine combined with ropivacaine can provide good intraoperative analgesia for thoracotomy due to thoracic paravertebral nerve block,which can provide better postoperative sedation and analgesia without increasing the incidence of postoperative adverse reactions.

关 键 词：地佐辛 罗哌卡因 胸椎旁神经阻滞 开胸手术 RAMSAY评分 VAS评分 

分 类 号：R971.2[医药卫生—药品]