胸椎旁神经阻滞联合右美托咪定全身麻醉对肾移植手术的效果评价  

Efficacy of thoracic paravertebral nerve block combined with dexmedetomidine general anesthesia in renal transplantation

作　　者：李普乐 阮孝国 王建平 朱永锋 林必盛 张加强 LI Pu-le;RUAN Xiao-guo;WANG Jian-ping;ZHU Yong-feng;LIN Bi-sheng;ZHANG Jia-qiang(Department of Anesthesia and Perioperative Medicine,People's Hospital of Zhengzhou University,Henan Province People's Hospital,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学人民医院、河南省人民医院麻醉与围术期医学科,河南郑州450000

出　　处：《广东医学》2022年第2期197-201,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划项目(SB201901090)。

摘　　要：目的评价胸椎旁神经阻滞联合右美托咪定全身麻醉在肾移植手术中的应用效果。方法选取择期行单侧肾移植手术的患者80例,ASA分级Ⅱ~Ⅲ级,年龄18~65岁,体质指数18~30 kg/m^(2),采用随机数字表法分为G组、GP组、GD组和DPG组共4组,每组20例。其中GP组和DPG组于麻醉前30 min行超声引导下胸9、11两点椎旁神经阻滞,每点注入0.33%罗哌卡因10 mL;GD组和DPG组于麻醉诱导前10 min静脉输注右美托咪定0.5μg/kg,10 min泵注完毕。记录瑞芬太尼用量、拔管时间、PACU停留时间;于术后2、6、12、24 h分别记录Ramsay评分、补救镇痛情况、发生恶心呕吐等不良反应的情况。结果与G组相比,GP组和GD组的患者高血压、心动过速发生率降低,苏醒时间、拔管时间减少,瑞芬太尼、丙泊酚用量减少,差异有统计学意义(P<0.05);与GP组比较,GD组心动过速发生率降低、心动过缓发生率增加,差异有统计学意义(P<0.05);而DPG组较GP组高血压、心动过速、心动过缓发生率降低,苏醒时间、拔管时间减少,瑞芬太尼、丙泊酚用量减少,差异有统计学意义(P<0.05);与GD组比较,DPG组高血压、心动过缓发生率降低,苏醒时间、拔管时间减少,瑞芬太尼、丙泊酚用量减少,差异有统计学意义(P<0.05)。结论胸椎旁神经阻滞联合右美托咪定全身麻醉能减少肾移植手术中全麻药物用量,提供有效的术后镇痛,有利于患者术后恢复,可作为更优化的麻醉选择。Objective To evaluate the efficacy of thoracic paravertebral nerve block combined with dexmedetomidine general anesthesia in renal transplantation.Methods Eighty patients(ASA GradeⅡ to Ⅲ,age 18 to 65 years,and BMI 18 to 30 kg/m^(2))were divided into 4 groups by random number table(n=20),general anesthesia group(Group G),general anesthesia+paravertebral block group(Group GP),general anesthesia+dexmedetomidine intravenous infusion(Group GD),dexmedetomidine intravenous infusion combined with paravertebral block+general anesthesia group(Group DPG).In Group GP and DPG,ultrasound-guided paravertebral nerve blocks were performed at T_(9) and T_(11) 30 min before anesthesia,and 0.33%ropivacaine 10 mL was injected at each point.Participants in Group GD and DPG received intravenously injection of dexmedetomidine 0.5μg/kg 10 min before induction of anesthesia,and completed in 10 min.Remifentanil dosage,extubation time and PACU residence time were recorded.Ramsay score,remedial analgesia,nausea and vomiting and other adverse reactions were recorded 2,6,12 and 24 h after operation.Results Compared with Group G,in Group GP and GD the incidences of hypertension and tachycardia were significantly reduced,the time to wake up and extubation was significantly shortened,and the dosages of remifentanil and propofol were significantly decreased(P<0.05).Compared with Group GP,in Group GD the incidence of tachycardia was significantly reduced and bradycardia was significantly increased(P<0.05).Compared with Group GP,Group DPG had significantly lower incidences of hypertension,tachycardia and bradycardia,shorter time to wake up and extubation,and lower dosages of remifentanil and propofol(P<0.05).Compared with Group GD,Group DPG had significantly lower incidences of hypertension and bradycardia,shorter time to wake up and extubation,and reduced dosage of remifentanil and propofol(P<0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia using dexmedetomidine can reduce the dosage of general anesthetics d

关 键 词：右美托咪定 神经传导阻滞 全身麻醉 肾脏移植 

分 类 号：R614.2[医药卫生—麻醉学] R614.4[医药卫生—外科学]