罗哌卡因复合不同剂量右美托咪定在中老年胸腰椎手术超声引导下双侧竖脊肌平面阻滞中的应用效果比较  

Comparison of Ropivacaine Combined with Different Doses of Dexmedetomidine for Ultrasound-Guided Bilateral Erector Spinae Plane Block in Middle-Aged and Elderly Patients undergoing Thoracolumbar Spine Surgery

作　　者：张懿兰 何谦 王丹 袁超[1] 温晶 ZHANG Yi-lan;HE Qian;WANG Dan;YUAN Chao;WEN Jing(Department of Anesthesiology,Baoding Second Hospital,Baoding 071000,China;Operating Room,Baoding Second Hospital,Baoding 071000,China;Department of Anesthesiology,Shijiazhuang Hospital of Traditional Chinese Medicine,Shijiazhuang 050000,China)

机构地区：[1]保定市第二医院麻醉科,河北保定071000 [2]石家庄市中医院麻醉科,河北保定071000 [3]保定市第二医院手术室,石家庄050000

出　　处：《南昌大学学报（医学版）》2023年第1期55-60,共6页Journal of Nanchang University：Medical Sciences

基　　金：保定市科技计划项目(2041ZF206)。

摘　　要：目的 比较罗哌卡因复合不同剂量右美托咪定在中老年胸腰椎手术超声引导下双侧竖脊肌平面阻滞(ESPB)中的应用效果。方法 应用前瞻性研究方法,按照随机数字表法和1:1:1实验设计原则,将2020年10月至2022年3月保定市第二医院收治的156例需行胸腰椎手术治疗的中老年患者分为A、B、C组,每组52例。3组均行罗哌卡因复合右美托咪定超声引导下双侧ESPB,其中A、B、C组右美托咪定剂量分别为0.5、1.0、1.5μg·kg^(-1)。比较3组入室前(T_(1))、手术切皮时(T_(2))、术毕时(T_(3))、气管拔管时(T_(4))血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]及应激指标[醛固酮(ALD)、皮质醇(Cor)],术后各时间点舒适度评分(BCS评分),术后舒芬太尼用量,术后48 h患者自控静脉镇痛(PCIA)按压次数、补救镇痛次数和疼痛程度[采用视觉模拟评分法(VAS)评价],术后各时间点匹兹堡睡眠质量指数(PSQI)评分及不良反应发生情况。结果 B、C组T_(2)、T_(3)、T_(4)时点HR、MAP值及血清ALD、Cor水平均显著低于A组(P<0.05),术后2、4、6、12、24、48 h BCS评分均显著高于A组(P<0.05),术后舒芬太尼用量、术后48 h PCIA按压次数和补救镇痛次数、术后48 h VAS评分及术后第1、2天PSQI评分均显著低于A组(P<0.05);但B组与C组上述各指标比较差异均无统计学意义(P>0.05)。A、B组不良反应发生率分别为3.85%、5.77%,显著低于C组的19.23%(P<0.05),但A组与B组不良反应发生率比较差异无统计学意义(P>0.05)。结论 中老年胸腰椎手术超声引导下双侧ESPB中采用罗哌卡因复合右美托咪定,推荐右美托咪定剂量为1.0μg·kg^(-1),可获得良好的麻醉效果,且安全性高。Objective To compare the efficacies of ropivacaine combined with different doses of dexmedetomidine for ultrasound-guided bilateral erector spinae plane block(ESPB)in middle-aged and elderly patients undergoing thoracolumbar spine surgery.Methods Using prospective research method,156 middle-aged and elderly patients scheduled for thoracolumbar surgery in Baoding Second Hospital from October 2020 to March 2022 were divided into three groups according to the random number table method and the 1[BFZ]:1:[BFB]1 experimental design principle,with 52 patients in each group.The groups A,B and C were given ropivacaine combined with 0.5,1.0 and 1.5μg·kg^(-1) dexmedetomidine for ultrasound-guided bilateral ESPB,respectively.The hemodynamic indicators heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SpO_(2))and the stress indicators serum aldosterone(ALD)and cortisol(Cor)were determined before entering the operating room(T_(1)),at the time of surgical incision(T_(2)),at the end of operation(T_(3)),and at the time of tracheal extubation(T_(4)).Furthermore,Bruggrmann comfort scale(BCS)score,sufentanil consumption,Pittsburgh sleep quality index(PSQI)score and adverse reactions were observed after operation.The number of patient-controlled intravenous analgesia(PCIA)compressions,number of remedial analgesia and visual analogue scale(VAS)score were recorded at 48 hours after operation.Results The HR,MAP and serum levels of ALD and Cor in group B or C were lower than those in group A at T_(2),T_(3) and T_(4)(P<0.05).The BCS scores in group B or C were higher than those in group A at 2,4,6,12,24 and 48 hours after operation(P<0.05).The postoperative sufentanil dosage,number of PCIA compressions at 48 hours postoperatively,number of remedial analgesia at 48 h postoperatively,VAS scores at 48 hours postoperatively,and PSQI scores at 1 and 2 days postoperatively in group B or C were lower than those in group A(P<0.05),But there was no significant difference between Group B and Group C(P>0.05).The incidence of ad

关 键 词：胸腰椎手术 罗哌卡因 右美托咪定 超声引导 竖脊肌平面阻滞 

分 类 号：R614[医药卫生—麻醉学]