不同浓度罗哌卡因胸横肌平面阻滞对冠状动脉旁路移植患者术后镇痛效果的影响  

Effects of different concentrations of ropivacaine for transversus thoracic plane block on postoperative analgesia in patients with coronary artery bypass grafting

作　　者：赵靓 杨洪光[2] 辛艳[2] 李会[2] 帅训军[2] 侯念果[2] 闫红 艾登斌[2] ZHAO Liang;YANG Hong-guang;XIN Yan;LI Hui;SHUAI Xun-jun;HOU Nian-guo;YAN Hong;AI Deng-bin(School of Anesthesiology,Weifang Medical University,Weifang SHANDONG 261053,China;Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao SHANDONG 266011,China)

机构地区：[1]潍坊医学院麻醉学院,山东潍坊261053 [2]青岛市市立医院麻醉科,山东青岛266011

出　　处：《中国新药与临床杂志》2021年第11期767-771,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：山东省青岛市医疗卫生优秀人才培养项目(青卫科教字[2019]6号)。

摘　　要：目的评价超声引导下行不同浓度罗哌卡因双侧胸横肌平面(TTP)阻滞对接受冠状动脉旁路移植术患者术后镇痛效果的影响。方法将择期行冠状动脉旁路移植术的60例患者随机分为单纯全身麻醉(全麻)组(C组)、0.375%罗哌卡因TTP阻滞联合全麻组(R1组)及0.25%罗哌卡因TTP阻滞联合全麻组(R2组),每组20例。气管插管后,R1组和R2组患者行超声引导下双侧TTP阻滞,每侧分别注入0.375%或0.25%罗哌卡因20 mL,C组未行阻滞操作。3组麻醉诱导和维持方法相同,术后均给予患者自控静脉镇痛。记录3组术中舒芬太尼用量、术后24 h内镇痛液用量、补救性镇痛药物应用情况,评估术后12、24 h静息和运动状态下疼痛视觉模拟量表(VAS)评分,观察术后恶心呕吐等不良事件发生情况。结果 C组术中舒芬太尼用量及术后24 h内镇痛液用量高于R1组和R2组(P <0.05),且R2组高于R1组(P <0.05)。术后12 h,C组静息和运动VAS评分均显著高于R1组和R2组(P <0.05),R1组运动VAS评分低于R2组(P <0.05),而静息VAS评分组间比较无显著差异(P> 0.05);术后24 h,R1组VAS评分显著低于R2组和C组(P <0.05)。术后12 h内,C组补救镇痛药应用率显著高于R1组和R2组(P <0.05);术后12~24 h,R1组补救镇痛药应用率显著低于R2组和C组(P <0.05);术后24~48 h,R1组补救镇痛药应用率显著低于C组(P <0.05)。3组术后气管导管拔除时间、ICU滞留时间比较无显著差异(P <0.05),均未出现穿刺部位血肿,C组恶心呕吐发生率高于R1组和R2组(40%vs.10%和15%,P <0.05)。结论 0.375%罗哌卡因超声引导下行双侧TPP阻滞联合全麻可为冠状动脉旁路移植术患者提供有效的围术期镇痛。AIM To evaluate the effects of different concentrations of ropivacaine under ultrasound guidance for bilateral transversus thoracic plane(TPP) block on postoperative analgesia in patients undergoing coronary artery bypass graft.METHODS Using a random number table method,60 patients undergoing elective coronary artery bypass surgery were divided into simple general anesthesia group(group C),0.375% ropivacaine TTP block combined with general anesthesia group(group R1) and 0.25% ropivacaine TTP block combined with general anesthesia group(group R2),20 cases in each group.After endotracheal intubation,ultrasound-guided bilateral TTP block was performed in the group R1 and group R2(0.375%,0.25% ropivacaine 20 mL was injected at each side),and no block operation in the group C.The induction and maintenance of anesthesia were the same in the three groups,and patients were given patient-controlled intravenous analgesia after the operation.The dosage of sufentanil in operation,the dosage of analgesic solution 24 h after operation,the application of additional analgesics,the VAS score of pain 12 h and 24 h after the operation in resting and moving state,and the occurrence of adverse events such as postoperative nausea and vomiting were observed.RESULTS The dosage of sufentanil in operation and analgesic solution during 24 h after operation in the group C were higher than those in the group R1 and group R2,and higher in the group R2 compared with group R1(P < 0.05).At 12 h after operation,the VAS scores in the group C were significantly higher than those in the group R1 and group R2(P < 0.05);the VAS score of moving state in the group R1 was lower than that in the group R2(P < 0.05),but no significant difference between groups in VAS score of resting state(P > 0.05).At 24 h after operation,the VAS scores in the group R1 were significantly lower than those in the group C and group R2(P < 0.05).The application rate of additional analgesics in the group C was significantly higher than those in the other two groups within 12 h

关 键 词：罗哌卡因 舒芬太尼 冠状动脉旁路移植术 镇痛 胸横肌平面阻滞 

分 类 号：R971[医药卫生—药品]