罗哌卡因联合舒芬太尼用于胸腔镜肺叶切除术患者的临床研究  

Clinical trial of ropivacaine combined with sufentanil in the treatment of patients undergoing thoracoscopic lobectomy

作　　者：李柏东[1] 姜平秀[1] 姜文波[1] LI Bai-dong;JIANG Ping-xiu;JIANG Wen-bo(Department of Thoracic and Cardiac Surgery,Daqing Longnan Hospital(The Fifth Affiliated Hospital of Qiqihar Medical College),Daqing 163453,Heilongjiang Province,China)

机构地区：[1]大庆龙南医院/齐齐哈尔医学院第五附属医院胸心外科,黑龙江大庆163453

出　　处：《中国临床药理学杂志》2024年第21期3076-3081,共6页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察罗哌卡因注射液联合舒芬太尼注射液全程硬膜外镇痛对胸腔镜肺叶切除术患者血流动力学、应激反应及术后疼痛的影响。方法将胸腔镜肺叶切除术患者按队列法分为试验组和对照组。2组患者均于术前行硬膜外穿刺置管术,对照组于硬膜外导管推注0.125%盐酸罗哌卡因注射液10 mg+0.9%NaCl注射液共8 mL,试验组于硬膜外导管推注0.125%盐酸罗哌卡因注射液10 mg+0.5μg·mL^(-1)枸橼酸舒芬太尼注射液4μg共8 mL,术中间断以同样浓度药物维持;关闭胸膜前连接硬膜外镇痛泵,对照组镇痛配方为0.125%盐酸罗哌卡因注射液400 mg,试验组镇痛配方为0.125%盐酸罗哌卡因注射液400 mg+0.5μg·mL^(-1)枸橼酸舒芬太尼注射液0.5 mg。比较2组患者术中血流动力学指标[心率(HR)、平均动脉压(MAP)],血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)水平变化,术后急性疼痛、术后镇痛补救和慢性疼痛发生情况,并进行安全性评价。结果本研究共入组患者80例,对照组38例,试验组42例。试验组和对照组气管插管即刻(T_(1))的HR分别为(80.35±9.62)和(88.24±10.35)beat·min^(-1),MAP分别为(95.07±8.51)和(98.46±9.05)mmHg;切皮时(T_(2)),试验组和对照组的HR分别为(75.33±9.21)和(80.65±10.63)beat·min^(-1),MAP分别为(94.33±8.43)和(99.06±6.58)mmHg;术毕(T_(4)),试验组和对照组血清E水平分别为(53.17±9.79)和(60.79±8.58)ng·L^(-1),NE水平分别为(52.33±8.22)和(59.96±8.89)ng·L^(-1),Cor水平分别为(22.75±4.63)和(28.64±5.02)mg·L^(-1);术后24 h(T_(5)),试验组和对照组血清E水平分别为(54.27±9.15)和(62.28±8.33)ng·L^(-1),NE水平分别为(55.34±9.18)和(62.07±9.58)ng·L^(-1),Cor水平分别为(24.19±4.52)和(30.57±4.79)mg·L^(-1),术后躁动发生率分别为7.14%(3/例42例)和23.68%(9例/38例),术后硬膜外自控镇痛首次按压时间分别为(13.67±2.74)和(11.35±2.28)h,术后72 h内补救镇痛药物剂量分别为(120.73±34.36)和(Objective To observe the effects of whole-course epidural analgesia with ropivacaine injection and sufentanil injection on hemodynamics,stress response and postoperative pain in patients undergoing thoracoscopic lobectomy.Methods Patients who underwent thoracoscopic lobectomy were divided into the treatment group and the control group according to the cohort method.Both groups underwent epidural puncture and catheterization before surgery.The control group was given bolus injection of 10 mg of 0.125%ropivacaine hydrochloride injection and 09%NaCl injection(8 mL in total)via epidural catheter.The treatment group was given bolus injection of 10 mg of 0.125%ropivacaine hydrochloride injection and 4μg of 0.5μg·mL^(-1)sufentanil citrate injection(8 mL in total)via epidural catheter.Analgesia was maintained with the same concentration of drugs during the surgery.The epidural analgesia pump was used before closing the pleura.The analgesic formula for the control group consisted of 400 mg of 0.125%ropivacaine hydrochloride injection,and the analgesic formula for the treatment group consisted of 400 mg of 0.125%ropivacaine hydrochloride injection and 0.5 mg of 0.5μg·mL^(-1)sufentanil citrate injection.Changes in hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)],serum epinephrine(E),norepinephrine(NE)and cortisol(Cor)during surgery,occurrence of postoperative acute pain,postoperative remedial analgesia,and chronic pain were compared between the two groups.Safety was evaluated.Results A total of 80 patients were enrolled in the study,with 38 in the control group and 42 in the treatment group.The heart rates(HR)of the treatment and control groups were(80.35±9.62)and(88.24±10.35)beat·min^(-1)at immediate tracheal intubation(T_(1));and their mean arterial pressures(MAP)were(95.07±8.51)and(98.46±9.05)mmHg respectively.At skin incision(T_(2)),HR of the treatment and control groups were(75.33±9.21)and(80.65±10.63)beat·min^(-1),respectively;MAP were(94.33±8.43)and(99.06±6.58)mmHg,respectively.Post-o

关 键 词：盐酸罗哌卡因注射液 枸橼酸舒芬太尼注射液 胸腔镜肺叶切除术 全程硬膜外镇痛 血流动力学 应激反应 疼痛 

分 类 号：R971.2[医药卫生—药品]