超声引导下罗哌卡因联合艾司氯胺酮椎旁阻滞技术在胸腔镜肺叶切除术中的应用价值  

Application value of ultrasound guided ropivacaine combined with esketamine paravertebral block in thoracoscopic bectomy

作　　者：王凯[1] 李宝强 葛磊[1] 徐茂华 高岳 张念亮[1] WANG Kai;LI Bao-qiang;GE Lei;XU Mao-hua;GAO Yue;ZHANG Nian-liang(Department of Anesesiology.People's Hospital,Rizhao 276827,Shandong,lobectomy thesiology,Rizhao People's Hospital,Rizhao 276827,Shandong,China)

机构地区：[1]日照市人民医院麻醉科,山东日照276827

出　　处：《生物医学工程与临床》2023年第3期310-315,共6页Biomedical Engineering and Clinical Medicine

基　　金：山东省医学会舒适化医疗临床科研专项基金项目(YXH2020ZX027)。

摘　　要：目的分析超声引导下罗哌卡因联合艾司氯胺酮椎旁阻滞技术在胸腔镜肺叶切除术中的应用价值。方法选择2021年4月至10月日照市人民医院收治的全身麻醉下胸腔镜肺叶切除术患者60例,其中男性36例,女性24例;年龄32~59岁,平均年龄46.67岁;身体质量指数(BMI)21.3~27.2 kg/m2,平均BMI 24.08 kg/m2。依照随机信封法分为静脉自控镇痛组(Ⅰ组)、胸椎旁阻滞罗哌卡因镇痛组(Ⅱ组)和胸椎旁阻滞艾司氯胺酮联合罗哌卡因镇痛组(Ⅲ组)。记录患者神经阻滞时、2 h各时间点基础指标,记录拔管后30 min、2 h、24 h、48 h、72 h静息和咳嗽时视觉模拟量表(VAS)评分。术后随访3 d,记录静脉患者自控镇痛(PCIA)泵按压次数,观察术后并发症发生和患者镇痛效果满意度。术前1 d及术后48 h时采用焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分对患者心理状态进行评估。结果阻滞后2 hⅠ组、Ⅱ组血压[(79.94±1.12)mmHg、(80.83±1.43)mmHg]、心率[(80.95±1.32)次/分、(79.99±1.29)次/分]、血氧饱和度[(96.17±0.83)%、(96.39±0.41)%]低于神经阻滞时[(85.51±2.12)mmHg、(84.01±1.92)mmHg,(82.32±1.22)次/分、(81.98±1.29)次/分,(97.40±0.49)%、(96.84±0.51)%],而呼吸频率[(19.48±1.19)次/分、(18.99±1.73)次/分]高于神经阻滞时[(18.37±1.29)次/分、(18.19±1.43)次/分];其中Ⅲ组患者血压[(85.11±1.29)mmHg]、心率[(82.85±1.22)次/分]、血氧饱和度[(97.02±0.29)%]明显高于Ⅰ组、Ⅱ组,呼吸频率[(17.93±1.64)次/分]显著低于Ⅰ组、Ⅱ组(P<0.05)。拔管后2 h、24 h、48 h及72 h时3组静息时和咳嗽时VAS评分[2 h:静息时(4.85±0.84)分、(4.91±0.73)分、(3.83±0.43)分;咳嗽(5.45±0.65)分、(5.53±0.68)分、(4.12±0.47)分。24 h:静息时(4.48±0.32)分、(4.39±0.28)分、(3.11±0.32)分,咳嗽(5.12±0.65)分、(5.01±0.41)分、(3.59±0.32)分。48 h:静息时(4.12±0.51)分、(4.18±0.32)分、(2.74±0.22)分,咳嗽(4.58±0.43)分、(4.71±0.39)分、(3.12±0.2Objective To analyze the application value of ultrasound guided ropivacaine combined with esketamine paravertebral block in thoracoscopic lobectomy.Methods From April to October 2021,a total of 60 patients performed thoracoscopic lobectomy under general anesthesia were enrolled,which included 36 males and 24 females,aged 32-59 years old with mean age of 46.67 years old;body mass index(BMI)was 21.3-27.2 kg/m2 with mean BMI of 24.08 kg/m2.According to random envelope method,all of them were divided into intravenous patient-controlled analgesia group(group I),thoracic paravertebral block ropivacaine analgesia group(group II)and thoracic paravertebral block esketamine combined with ropivacaine analgesia group(group II);The basic indexes at the time of nerve block and 2-hour post nerve block were recorded,and the visual analogue scale(VAS)scores of resting and cough at 30-minute,2-hour,24-hour,48-hour and 72-hour post extubation were recorded.All patients were followed up for 3-day post operation,the pressing of patient-controlled intravenous analgesia(PCIA)pump was recorded,and the occurrence of postoperative complications as well as satisfaction of patients with analgesic effect were observed.The self-rating anxiety scale(SAS)score and self-rating depression scale(SDS)score were used to evaluate psychological status of patients at 1-day before operation and 48-hour post operation.Results The blood pressure[(79.94±1.12)mmHg,(80.83±1.43)mmHg],heart rate[(80.95±1.32)times/minutes,(79.99±1.29)times/minutes]and oxygen saturation[(96.17±0.83)%,(96.39±0.41)%]of group I and group II at 2-hour post block were lower than those at nerve block[(85.51±2.12)mmHg,(84.01±1.92)mmHg;(82.32±1.22)times/mintutes,(81.98±1.29)times/minutes;(97.40±0.49)%,(96.84±0.51)%],while respiratory rate[(19.48±1.19)times/minutes,(18.99±1.73)times/minutes]was higher than that of nerve block[(18.37±1.29)times/minutes,(18.19±1.43)times/minutes];The blood pressure[(85.11±1.29)mmHgl,heart rate[(82.85±1.22)times/minutes]and oxygen saturati

关 键 词：艾司氯胺酮 罗哌卡因 椎旁阻滞技术 胸腔镜肺叶切除术 

分 类 号：R614[医药卫生—麻醉学] R655.3[医药卫生—外科学]