不同浓度罗哌卡因行胸椎旁神经阻滞麻醉对老年胸腔镜肺叶切除术患者围手术期镇痛的效果  

Perioperative Analgesic Effect of Different Concentrations of Ropivacaine for Thoracic Paravertebral Block Anesthesia in Elderly Patients Undergoing Thoracoscopic Lobectomy

作　　者：杨小强 丁伟[1] 张小亮[1] 刘成森[1] YANG Xiao-qiang;DING Wei;ZHANG Xiao-liang;LIU Cheng-sen(Department of Anesthesiology,Gaozhou People's Hospital,Gaozhou 525200,Guangdong,China)

机构地区：[1]高州市人民医院麻醉科,广东高州525200

出　　处：《医学信息》2021年第24期131-134,共4页Journal of Medical Information

摘　　要：目的研究不同浓度罗哌卡因行胸椎旁神经阻滞麻醉(PVB)在老年患者胸腔镜肺叶切除术(VATS)中的镇痛效果。方法选取2020年3月-2021年2月于我院行VATS治疗的74例老年患者,按照随机数字表法分为A组(n=25)、B组(n=25)、C组(n=24)。所有患者均于术前行罗哌卡因PVB麻醉,A、B、C组罗哌卡因浓度分别为0.25%、0.50%、0.75%,比较三组不同状态(静息、咳嗽)、不同时间(术后5 min、术后2 h、12 h)疼痛视觉模拟评分(VAS)、苏醒时间、拔管时间、补救镇痛情况、围术期体征指标[心率(HR)、平均动脉压(MAP)]、舒芬太尼与间羟胺的使用剂量、麻醉并发症。结果三组术后2 h、12 h VAS评分均有下降,且B组、C组VAS评分低于A组(P<0.05),但B组、C组间比较,差异无统计学意义(P>0.05);A组、B组苏醒时间及拔管时间短于C组,而B组、C组补救镇痛情况少于A组(P<0.05);C组围术期HR、MAP水平存在明显波动,且与A、B组比较,差异有统计学意义(P<0.05),而A组与B组围术期HR、MAP水平比较,差异无统计学意义(P>0.05);舒芬太尼使用剂量由高到低依次为B组、A组、C组,间羟胺使用剂量由高到低依次为C组、A组、B组(P<0.05);C组麻醉并发症高于A组、B组(P<0.05),而A组、B组麻醉并发症比较,差异无统计学意义(P>0.05)。结论0.50%浓度罗哌卡因PVB麻醉在老年患者VATS方案中具有理想效果,其镇痛效果与高浓度相似,但围术期血流动力学更为稳定,且药物用量少于低浓度方案,麻醉并发症风险低。Objective To study the analgesic effect of different concentrations of ropivacaine for thoracic paravertebral block(PVB)anesthesia in elderly patients undergoing video-assisted thoracic surgery(VATS).Methods A total of 74 elderly patients who underwent VATS in our hospital from March 2020 to February 2021 were randomly divided into group A(n=25),group B(n=25)and group C(n=24).All patients were anesthetized with ropivacaine PVB before operation.The concentrations of ropivacaine in groups A,B and C were 0.25%,0.50%and 0.75%,respectively.The visual analogue scale(VAS)of different states(rest,cough)and different times(5 min,2 h and 12 h after operation),recovery time,extubation time,remedial analgesia,perioperative signs[heart rate(HR),mean arterial pressure(MAP)],dosage of sufentanil and m-hydroxylamine,and anesthesia complications were compared among the three groups.Results The VAS scores at 2 h and 12 h after operation in the three groups were decreased,and the VAS scores in groups B and C were lower than those in group A(P<0.05),but there was no significant difference between groups B and C(P>0.05).The recovery time and extubation time in groups A and B were shorter than those in group C,while salvage analgesia in groups B and C was less than that in group A(P<0.05).Perioperative HR and MAP levels in group C fluctuated significantly,and were statistically different from groups A and B(P<0.05),while there was no statistically significant difference in HR and MAP levels in groups A and B during perioperative period(P>0.05).The dosage of sufentanil was group B,group A,and group C from high to low,and the dosage of metahydroxylamine was group C,group A,and group B from high to low(P<0.05).Anesthesia complications in group C were higher than those in groups A and B(P<0.05),while there was no significant difference in anesthesia complications in groups A and B(P>0.05).Conclusion The 0.50%ropivacaine PVB anesthesia has ideal effect in elderly patients with VATS scheme,and its analgesic effect is similar to that of high

关 键 词：胸椎旁神经阻滞麻醉 围手术期镇痛 胸腔镜肺叶切除术 罗哌卡因 

分 类 号：R734.2[医药卫生—肿瘤]