超声引导下小剂量右美托咪定复合罗哌卡因胸椎旁阻滞在胸腔镜手术麻醉诱导前应用的效果观察  

Effect of ultrasound-guided thoracic paravertebral nerve block with small-dose dexmedetomidine and ropivacaine before anesthesia induction in thoracoscopic surgery

作　　者：王中玉[1] 王铭 郭培霞 陈欢[2] 张朔 WANG Zhong-yu;WANG Ming;GUO Pei-xia;CHEN Huan;ZHANG Shuo(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Anesthesiology,Nanyang Central Hospital,Nanyang,Henan 473006,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,河南郑州450052 [2]南阳市中心医院麻醉科,河南南阳473006

出　　处：《中华实用诊断与治疗杂志》2021年第3期310-313,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关项目(192102310127)。

摘　　要：目的观察胸腔镜手术麻醉诱导前行超声引导下小剂量右美托咪定复合罗哌卡因胸椎旁阻滞的应用效果。方法92例行胸腔镜手术治疗的患者于麻醉诱导前行超声引导下胸椎旁神经阻滞,其中注射右美托咪定0.5μg/kg+质量分数0.375%罗哌卡因混合液15mL阻滞麻醉者46例为观察组,注射质量分数0.375%罗哌卡因15mL者46例为对照组,针刺法判断痛觉减轻为椎旁神经阻滞起效,给药30min后常规麻醉诱导,术中根据脑电双频指数调整七氟烷吸入浓度,效应室靶控输注瑞芬太尼维持镇痛。比较2组手术时间、出血量、输液量(复方氯化钠注射液)、七氟烷及瑞芬太尼应用剂量;比较2组麻醉前(T_(1))、切皮后1h(T_(2))、手术结束(T_(3))、术后2h(T_(4))时的平均动脉压(mean arterial pressure,MAP)、心输出量(cardiac output,CO)、每搏量(stroke volume,SV)、心率;比较2组痛觉阻滞起效时间、阻滞平面固定时间、气管导管拔除时间和复苏室停留时间;比较2组术后2、6、12、24h视觉模拟评分及不良反应发生情况。结果观察组1例患者术中出血转为开胸手术,对照组1例患者术后胸导管瘘需再次手术,剔除研究。观察组七氟烷[(22.24±2.35)mL]、瑞芬太尼[(613.35±25.45)μg]应用剂量少于对照组[(29.53±3.02)mL、(712.55±40.34)μg](P<0.05)。2组手术时间、出血量、输液量比较差异均无统计学意义(P>0.05)。观察组T_(2)、T_(3)、T_(4)时MAP[(88.14±8.15)、(87.92±8.25)、(88.56±8.17)mm Hg]、CO[(4.84±0.43)、(4.91±0.41)、(4.88±0.42)L/min]均高于对照组[MAP:(84.43±8.72)、(84.33±8.21)、(84.68±8.16)mm Hg;CO:(4.37±0.43)、(4.42±0.44)、(4.51±0.45)L/min](P<0.05),T_(1)时MAP、CO及不同时间点SV、心率与对照组比较差异均无统计学意义(P>0.05)。2组T_(2)、T_(3)、T_(4)时MAP均低于同组T_(1)时,CO均高于同组T_(1)时(P<0.05);2组T_(2)、T_(3)、T_(4)时SV、心率与同组T_(1)时比较差异均无统计学意义(P>0.05)。观察�Objective To observe the application of small-dose dexmedetomidine combined with ropivacaine in ultrasound-guided thoracic paravertebral nerve block(TPVB)before anesthesia induction in thoracoscopic surgery.Methods Ninety-two patients was performed TPVB before anesthesia induction in thoracoscopic surgery,in which 46 patients received mixed solution containing 15mL of 0.375%ropivacaine and 0.5μg/kg dexmedetomidine(observation group),and the other 46patients was given 15mL of 0.375%ropivacaine(control group).The beginning of pain relieving was regarded as onset of TPVB by acupuncture.After 30min,conventional anesthesia induction was started.According to the bispectral index(BIS),inspirated concentration of sevoflurane was adjusted during operation and effect-site target-controlled infusion of remifentanil was performed to maintain analgesia.The operation time,intraoperative blood loss,transfusion volume of Compound Sodium Chloride Injection,dose of sevoflurane and dose of remifentanil were compared between two groups.The mean arterial pressure(MAP),cardiac output(CO),stroke volume(SV)and heart rate were recorded before anesthesia(T_(1)),one hour after skin incision(T_(2)),at the end of operation(T_(3)),and two hours after operation(T_(4))were compared between two groups.The onset time of TPVB,the fixed time of the block plane,the time of tracheal tube withdrawal,the length of resuscitation room stay,the visual analogue scale scores 2,6,12and 24hafter operation,and the incidence of adverse reactions were compared between two groups.Results Two patients were eliminated including one patient converting to thoracotomy due to intraoperative bleeding in observation group and one patient undergoing second operation due to fistula of thoracic duct in control group.The usage doses of sevoflurane and remifentanil were smaller in observation group((22.24±2.35)mL,(613.35±25.45)μg)than those in control group((29.53±3.02)mL,(712.22±40.34)μg)(P<0.05).There were no significant differences in the operation time,intraoperati

关 键 词：胸腔镜手术 胸椎旁神经阻滞 超声引导下 右美托咪定 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]