超声引导罗哌卡因复合右美托咪定胸椎旁神经阻滞在乳腺癌手术患者中的应用效果  

Application effect of ultrasound-guided Ropivacaine combined with Dexmedetomidine paravertebral nerve block in patients undergoing breast cancer surgery

作　　者：彭珍珠 范双炽 张辉明 PENG Zhenzhu;FAN Shuangchi;ZHANG Huiming(Department of Anesthesiology,Sanming First Hospital,Fujian Province,Sanming365000,China)

机构地区：[1]福建省三明市第一医院麻醉科,福建三明365000

出　　处：《中国当代医药》2023年第11期140-143,共4页China Modern Medicine

摘　　要：目的分析超声引导罗哌卡因复合右美托咪定胸椎旁神经阻滞在乳腺癌手术患者中的应用效果。方法选择2020年5月至2021年10月三明市第一医院接受乳腺癌手术的105例患者为研究对象,采用计算机随机数法分为罗哌卡因组(R组,52例)和复合组(RD组,53例)。两组均接受常规全麻,其中R组实施超声引导罗哌卡因胸椎旁神经阻滞麻醉,RD组实施超声引导罗哌卡因复合右美托咪定胸椎旁神经阻滞。比较两组麻醉后血流动力学变化、应激状态和术后疼痛情况。结果整体分析发现,舒张压(DBP)组间比较差异有统计学意义(P<0.05);肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(COR)水平和疼痛评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05);收缩压(SBP)、平均动脉压(MAP)和血氧饱和度(SpO2)组间比较、时间点比较及交互作用差异均无统计学意义(P>0.05)。进一步比较显示,RD组患者术后DBP高于R组,而术中、术后E、NE、COR水平以及不同时间点疼痛评分均低于R组,差异有统计学意义(P<0.05)。结论实施超声引导罗哌卡因复合右美托咪定胸椎旁神经阻滞术前注射能获得理想麻醉和镇痛效果,在缓解患者术后疼痛和应激水平,保持血流动力学水平稳定等方面具有积极意义。Objective To analyze the effect of ultrasound-guided Ropivacaine combined with Dexmedetomidine thoracic paravertebral nerve block in patients undergoing breast cancer surgery.Methods A total of 105 patients who underwent breast cancer surgery in the Sanming First Hospital from May 2020 to October 2021 were selected as the research objects and divided into ropivacaine group(R group,52 cases)and compound group(RD group,53 cases)by computer random number method.Both groups received general anesthesia,in which group R was subjected to ultrasound guided Ropivacaine thoracic paravertebral nerve block anesthesia,and group RD was subjected to ultrasound guided Ropivacaine combined with Dexmedetomidine thoracic paravertebral nerve block anesthesia.The hemodynamic changes,stress state and postoperative pain were compared between the two groups.Results The overall analysis showed that diastolic blood pressure(DBP)was significantly different betweengroups(P<0.05).There were significant differences in the level of epinephrine(E),norepinephrine(NE),cortisol(COR)and pain evaluation between groups,time point comparison and interaction(P<0.05).There were no significant differences in systolic blood pressure(SBP),mean arterial pressure(MAP)and oxygen saturation(SpO2)between groups,time point comparison and interaction(P>0.05).Further comparison showed that postoperative DBP in RD group was higher than that in R group,while intraoperative and postoperative levels of E,NE,COR and pain scores at different time periods were lower than those in R group,with statistical significances(P<0.05).Conclusion Ultrasound-guided preoperative injection of Ropivacaine combined with Dexmedetomidine in thoracic paravertebral nerve block can obtain ideal anesthetic and analgesic effects,which has positive significance in relieving postoperative pain and stress level and maintaining stable hemodynamic level.

关 键 词：超声引导 胸椎旁神经阻滞 右美托咪定 乳腺癌 血流动力学 应激 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]