罗哌卡因复合地塞米松胸椎旁神经阻滞用于Ivor-Lewis食管癌根治术的效果  

Effect of ropivacaine combined with dexamethasone on thoracic paravertebral block in Ivor-Lewis esophagectomy

作　　者：乔璐 贾梦醒 王立伟 张妍 丁文平 戚钰 QIAO Lu;JIA Mengxing;WANG Liwei;ZHANG Yan;DING Wenping;QI Yu(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学附属医院麻醉科,221006 [2]徐州市第四人民医院麻醉科

出　　处：《临床麻醉学杂志》2021年第6期579-582,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察超声引导下罗哌卡因复合地塞米松胸椎旁阻滞(TPVB)在Ivor-Lewis食管癌根治术中的应用效果。方法选择择期行Ivor-Lewis食管癌根治术患者60例,男29例,女31例,40~75岁,ASAⅠ—Ⅲ级。采用数字表法将患者随机分为两组:单纯罗哌卡因组(R组)和罗哌卡因复合地塞米松组(RD组),每组30例。全麻诱导前行超声引导下TPVB,R组采用0.5%罗哌卡因15 ml加生理盐水3 ml,RD组采用0.5%罗哌卡因15 ml加地塞米松0.15 mg/kg(用生理盐水稀释到3 ml)。记录镇痛持续时间、术后48 h内镇痛泵有效按压次数及补救镇痛例数,记录术后2、4、8、12、24、48 h静息和咳嗽时VAS疼痛评分,记录术后24 h内不良反应以及术后3个月慢性疼痛的发生情况。结果RD组镇痛持续时间明显长于R组,术后48 h内镇痛泵有效按压次数明显少于R组,术后2、4、8、12、24 h静息和咳嗽时VAS疼痛评分明显小于R组(P<0.05)。两组补救镇痛率和术后24 h内不良反应发生率差异无统计学意义。RD组术后3个月慢性疼痛发生率明显低于R组(P<0.05)。结论与单纯罗哌卡因比较,罗哌卡因复合地塞米松可延长食管癌根治术患者胸椎旁神经阻滞持续时间,增强镇痛效果,降低食管癌根治术患者术后慢性疼痛发生率。Objective To observe the effects of adding dexamethasone to ropivacaine on the quality and duration of ultrasound-guided thoracic paravertebral block(TPVB)in Ivor-Lewis esophagectomy.Methods Sixty adult patients undergoing Ivor-Lewis esophagectomy,29 males and 31 females,aged 40-75 years,ASA physical statusⅠ-Ⅲ,were allocated into the study.The patients were randomly divided into two groups by the digital table method:ropivacaine group(group R)and ropivacaine combined with dexamethasone group(group RD),30 cases in each group.Before general anesthesia induction,TPVB was performed under ultrasound guidance.Group R was treated with 0.5%ropivacaine 15 ml+normal saline 3 ml,and group RD was treated with 0.5%ropivacaine 15 ml+dexamethasone 0.15 mg/kg plus normal saline diluted to 3 ml.The duration of analgesia,the number of effective compressions of the analgesic pump within 48 hours after the operation,and the number of cases of remedial analgesia were recorded.The VAS pain scores for rest and cough 2,4,8,12,24,and 48 hours after the operation were recorded.Adverse reactions within 24 hours and the occurrence of chronic pain 3 months after surgery were recorded.Results The duration of analgesia in group RD was significantly longer than that in group R,and the number of effective compressions of the analgesic pump within 48 hours after the operation was significantly less than that in group R(P<0.05).The VAS pain scores for rest and cough 2,4,8,12,and 24 hours after the operation were significantly lower than those in group R(P<0.05).There was no statistically significant difference in the rate of salvage analgesia and the incidence of adverse reactions within 24 hours after the operation between the two groups.The incidence of chronic pain in group RD was significantly lower than that in group R 3 months after surgery(P<0.05).Conclusion Addition of dexamethasone to ropivacaine significantly prolongs the duration of analgesia,enhances analgesic effect,and reduces the incidence of chronic postsurgical pain compared t

关 键 词：罗哌卡因 地塞米松 胸椎旁神经阻滞 食管癌根治术 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]