罗哌卡因混合右美托咪定竖脊肌平面阻滞对椎间孔镜围术期的临床研究  

Clinical study of ropivacaine combined with dexmedetomidine for erector spinae plane block in perioperative period of foraminoscopic surgery

作　　者：杜静 邹士东 黄强[1] 孙玉兰[1] 蓝诺[1] DU Jing;ZOU Shidong;HUANG Qiang;SUN Yulan;LAN Nuo(Department of Anesthesiology,Shanxian Central Hospital(Huxi Hospital Affiliated to Jining Medical College),Heze 274300,China;Department of Orthopedics,Shanxian Central Hospital(Huxi Hospital Affiliated to Jining Medical College),Heze 274300,China)

机构地区：[1]单县中心医院(济宁医学院附属湖西医院)麻醉科,山东菏泽274300 [2]单县中心医院(济宁医学院附属湖西医院)骨科,山东菏泽274300

出　　处：《麻醉安全与质控》2021年第6期346-350,共5页Perioperative Safety and Quality Assurance

摘　　要：目的观察超声引导下右美托咪定混合罗哌卡因竖脊肌平面阻滞(ESPB)对椎间孔镜围手术期的临床效果。方法选取2020年8~12月行择期椎间孔镜手术患者60例,ASA分级Ⅰ或Ⅱ级,随机分为单纯罗哌卡因组(R组,n=30)和罗哌卡因混合右美托咪定组(D组,n=30),2组均采用超声引导下ESPB,R组给予0.3%罗哌卡因20 mL,D组给予1μg/kg右美托咪定混合0.3%罗哌卡因共20 mL,记录2组患者入室时、阻滞后5 min、10 min、15 min、20 min时的视觉模拟评分(VAS),记录手术消毒铺巾时(T_(0))、切皮穿刺时(T_(1))、椎板开窗时(T_(2))、髓核取出时(T_(3))、皮内缝合时(T_(4))各时间点平均动脉压(MAP)、心率(HR),记录术中心动过缓、低血压、口干不良反应的情况,记录术前、术后4、8、12、24 h各时间点Oswestry功能障碍指数(ODI)及术后镇痛药总用量。结果与R组相比,D组在5 min、10 min、15 min时的VAS评分明显降低,差异有统计学意义(P<0.05);R组在T_(1)、T_(2)、T_(3)时间点的MAP、HR明显高于D组,差异有统计学意义(P<0.05);2组患者不良反应无统计学意义(P>0.05);D组在术后8、12、24 h ODI和术后镇痛药总用量明显低于R组(P<0.05)。结论超声引导下右美托咪定1μg/kg混合0.3%罗哌卡因ESPB用于椎间孔镜手术时提高术中镇痛效果,术中循环功能平稳且无明显不良反应,术后利于患者各项机能的恢复并减少镇痛药总用量。Objective To observe the effect of ropivacaine combined with dexmedetomidine on erector spinae plane block(ESPB)under ultrasound guidance in the perioperative period of foraminoscopic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients with elective foraminoscopic surgery,were enrolled and randomly divided into ropivacaine group(group R,n=30)and dexmedetomidine combined with ropivacaine group(group D,n=30).Both groups were guided by ultrasound with ESPB.Group D was given 20 mL of 1μg/kg dexmedetomidine mixed with 0.3%ropivacaine,and group R was given 20 mL of 0.3%ropivacaine.Related indicators were recorded,including VAS scores when entering the room,5 min,10 min,15 min,and 20 min after the block of two groups.MAP and HR at the surgical disinfection drape(T_(0)),skin incision and puncture(T_(1)),lamina window(T_(2)),nuclear removal(T_(3))and intradermal suture(T_(4))were recorded.Meanwhile the adverse reactions,such as bradycardia,hypotension and dry mouth,were recorded.The total dosage of ODI and postoperative analgesics at 4,8,12,and 24 h after surgery were also recorded.Results Compared with the group R,the VAS scores of the group D at 5 min,10 min,and 15 min were significantly lower,and the difference was statistically significant(P<0.05);the MAP and HR of the R group at the time points of T_(1),T_(2),and T_(3) were significantly higher than those of group D,the difference was statistically significant(P<0.05);there was no significant difference in adverse reactions between the two groups(P>0.05);the total dosage of ODI and postoperative analgesics at 8,12,and 24 h after surgery were significantly lower than those of group R(P<0.05).Conclusion Ultrasound-guided dexmedetomidine 1μg/kg combined with 0.3%ropivacaine erector spinae plane block can improve the analgesic effect during foraminoscopic surgery,and the circulatory function during the operation is stable.There are no obvious adverse reactions,it is beneficial to the recovery of various functions of the patient after the operation and can reduce the total do

关 键 词：右美托咪定 罗哌卡因 竖脊肌阻滞 椎间孔镜术 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]