右美托咪定联合罗哌卡因SAPB对老年胸椎间盘突出症行椎体植骨融合手术患者围手术期指标的影响  

Perioperative effects of dexmedetomidine combined with ropivacaine SAPB on elderly patients with thoracic disc herniation undergoing vertebral body fusion surgery

作　　者：何谦 张懿兰 王丹 宿亚敏 袁超[2] 温晶 崔子慧 葛磊[2] HE Qian;ZHANG Yilan;WANG Dan;SU Yamin;YUAN Chao;WEN Jing;CUI Zihui;GE Lei(Department of Anesthesiology,Shijiazhuang Hospital of Traditional Chinese Medicine,Tangshan 050000,China)

机构地区：[1]河北省石家庄市中医院麻醉科,050000 [2]保定市第二医院麻醉科

出　　处：《中国煤炭工业医学杂志》2024年第2期136-142,共7页Chinese Journal of Coal Industry Medicine

基　　金：保定市科技计划项目(编号:2041ZF206)。

摘　　要：目的 探究右美托咪定静脉滴注联合罗哌卡因单次前锯肌平面阻滞(SAPB)对老年胸椎间盘突出症(TDH)行椎体植骨融合手术患者围手术期指标的影响。方法 选取2019年1月—2022年12月在该院行椎体植骨融合手术的TDH患者122例纳入研究,采用随机数字表法将患者分为罗哌卡因SAPB组(R/SAPB组)和右美托咪定静脉滴注联合罗哌卡因SAPB组(Dex+R/SAPB组),各61例;分析二组患者临床基本资料、围手术期资料、术前(T0)、术后24h(T1)、术后72h(T2)时间段镇痛视觉模拟评分(VAS)及术后不良反应发生情况;酶联免疫吸附法(ELISA)检测术前、术后血清CRP、cTnI、S100β水平。结果 二组患者临床基本资料比较,差异无统计学意义(P>0.05);与R/SAPB组比较,Dex+R/SAPB组拔除气管导管时间、苏醒延迟占比、苏醒期躁动占比降低,维持镇痛时间延长(P<0.05);与R/SAPB组比较,Dex+R/SAPB组T1、T2时刻VAS评分均降低(P<0.05);Dex+R/SAPB组不良反应发生率低于R/SAPB组(P<0.05);术前T0时刻,二组患者血清因子CRP、cTnI、S100β水平比较,差异无统计学意义(P>0.05);术后T2时刻,二组患者血清CRP、cTnI、S100β因子水平均提升(P<0.05);T2时刻,与R/SAPB组比较,Dex+R/SAPB组患者血清CRP、cTnI、S100β因子水平降低(P<0.05);T2时刻,与R/SAPB组比较,术后发生不良反应组患者血清CRP、cTnI、S100β水平明显升高(P<0.05)。结论 罗哌卡因联合Dex静脉滴注可以降低TDH患者术后机体炎症反应、心肌损伤以及认知水平损伤程度,改善围手术期质量,降低术后不良反应发生率。Objective To explore the clinical efficacy of dextrometomidine intravenous drip combined with Ropivacaine single plane block of Serratus anterior muscle(SAPB)in elderly patients with thoracic disc herniation(TDH)undergoing vertebral body fusion surgery and postoperative serum CRP,cTnI,S100β.Methods One hundred and twenty-two TDH patients who underwent vertebral body fusion surgery in Shijiazhuang Hospital of Traditional Chinese Medicine from January 2019to December 2022were selected as subjects.The patients were randomly divided into two groups:the ropivacaine SAPB group(R/SAPB group)and the dexmedetomidine intravenous infusion combined with ropivacaine SAPB group(Dex+R/SAPB group).We collected basic clinical information,perioperative information,visual analgesia simulation scove(VAS)and postoperative adverse reactions in preoperative(T0),postoperative 24h(T1)and postoperative 72h(T2)periods.and incidence of postoperative adverse reactions for two groups of patients.ELISA detection of preoperative and postoperative serum CRP,cTnI,S100βHorizontal.Results There was little difference in basic clinical information between the two groups of patients(P>0.05).Compared with R/SAPB group,Dex+R/SAPB group had a decrease in the time to remove tracheal catheters,the proportion of delayed awakening,and the proportion of restless patients during the awakening period,while maintaining analgesia time was prolonged(P<0.05).Compared with R/SAPB group,Dex+R/SAPB group showed a decrease in VAS scores at T1and T2(P<0.05).The probability of adverse reactions in Dex+R/SAPB group was lower than that in R/SAPB group(P<0.05).There was no significant difference in the levels of serum factors CRP,cTnI and S100βbetween the two groups at time T0before operation(P>0.05).At T2after operation,the levels of serum CRP,cTnI and S100βincreased in both groups(P<0.05).At T2,compared with R/SABB group,the levels of serum CRP,cTnI and S100βin Dex+R/SABB group decreased(P<0.05).At T2,compared with R/SAPB group,the levels of serum CRP,cTnI and S100β

关 键 词：胸椎间盘突出症 椎体植骨融合手术 前锯肌平面阻滞 右美托咪定 术后镇痛 血清因子 

分 类 号：R614[医药卫生—麻醉学]