地佐辛复合罗哌卡因胸椎旁神经阻滞对术后镇痛效果的影响  

Effects of dezocine combined with ropivacaine on postoperative analgesia effects after thoracic paravertebral nerve block

作　　者：苗国瑞 王忠义 王福朝 张同军 孙学飞 靳红绪 陈金辉 MIAO Guorui;WANG Zhongyi;WANG Fuchao(Department of Anesthesia,The People of Hengshui City,Hebei,Hengshui 053000,China)

机构地区：[1]河北省衡水市人民医院麻醉科,053000

出　　处：《河北医药》2020年第21期3246-3248,3252,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20181574)。

摘　　要：目的观察地佐辛复合罗哌卡因胸椎旁神经阻滞在开胸手术中对全麻用药剂量及术后镇静镇痛效果的影响,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。方法择期行开胸手术肺叶切除患者60例,随机分为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):全凭静脉麻醉,不行椎旁神经阻滞,每组20例。记录3组患者手术结束时瑞芬太尼和丙泊酚的使用总剂量,拔管后达到要求镇静评分(Ramsay评分)给予的舒芬太尼总剂量,及术后48 h不良反应发生例数及镇痛泵按压次数。结果D组瑞芬太尼和丙泊酚使用总量明显低于R组与C组(P<0.05);R组瑞芬太尼和丙泊酚使用总量明显低于C组(P<0.05)。D组拔管后达到要求镇静评分(Ramsay评分)给予的舒芬太尼剂量明显低于R组与C组(P<0.05);R组拔管后达到要求镇静评分给予的舒芬太尼剂量明显低于C组(P<0.05)。D组患者术后48 h镇痛泵按压次数明显少于R组和C组(P<0.05);R组患者术后48 h镇痛泵按压次数明显少于C组(P<0.05)。D组与R组术后48 h不良反应发生率差异无统计学意义(P>0.05)。结论地佐辛复合罗哌卡因胸椎旁神经阻滞能减少开胸手术舒芬太尼、瑞芬太尼及丙泊酚使用剂量,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 effects of dezocine combined with ropivacaine on general anesthetic dosage during operation and postoperative analgesia effects after thoracic paravertebral nerve block.Methods A total of 60 patients who were ready to undergo pulmonary lobectomy though thoracotomy were randomly divided into three groups,with 20 patients in each group,which were ropivacaine compound dezocine group(group D):0.375%ropivacaine 0.3ml/kg was used for thoracic paravertebral nerve block(dezocine 0.1mg/kg),ropivacaine group(group R):0.375%ropivacaine 0.3ml/kg was used for thoracic paravertebral nerve block according,and control group(group C):dependent intravenous anesthesia,without thoracic paravertebral nerve block.The total dose of remifentanil and propofol at the end of surgery,and the total dose of sufentanil administered after extubation according to the required sedation score(Ramsay score),the cases with incidence of adverse reactions and the frequency of analgesia pump pressed within 48 hours after surgery were observed and and compared among the three groups.Results The total dose of remifentanil and propofol in group D was significantly lower than that in group R and group C(P<0.05).The total dosages of remifentanil and propofol in group R were significantly lower than that in group C(P<0.05).The total dosages of sufentanil administered after extubation for meeting the requirement of Ramsay score in group D were significantly lower than those in group R(P<0.05)and group C(P<0.05).Moreover the total dosages of sufentanil administered after extubation for meeting the requirement of Ramsay score in group R were significantly lower than those in group C(P<0.05).The frequency of analgesia pump pressed within 48 hours after surgery in group D was significantly lower than that in group R and group C(P<0.05).Moreover the frequency of analgesia pump pressed within 48 hours after surgery in group R was significantly lower than that in group C(P<0.05).However there was no significant difference in the incidenc

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

分 类 号：R971.1[医药卫生—药品]