罗哌卡因复合右美托咪定竖脊肌平面阻滞对胸腔镜肺叶切除患者术后应激和镇痛的影响  

Impact of erector spinae plane block with ropivacaine combined with dexmedetomidine on postoperative stress and analgesia in patients undergoing thoracoscopic lobectomy

作　　者：张小瑞 王晓睿 赵敏[1] 张建文[2] ZHANG Xiaorui;WANG Xiaorui;ZHAO Min;ZHANG Jianwen(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesia,the Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital),Taiyuan 030032,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第三医院(山西白求恩医院,山西医学科学院,同济山西医院)麻醉科,太原030032

出　　处：《西北药学杂志》2025年第1期22-26,共5页Northwest Pharmaceutical Journal

基　　金：山西省重点研发计划项目(编号:201803D31135)。

摘　　要：目的 探究超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞对胸腔镜肺叶切除患者术后应激和镇痛的影响。方法 选取全身麻醉下行胸腔镜肺叶切除的患者60例作为研究对象,用随机数字表法分为R组(30例,竖脊肌平面阻滞注入0.5%罗哌卡因30 mL)和RD组(30例,竖脊肌平面阻滞注入0.5%罗哌卡因30 mL+右美托咪定1μg·kg^(-1))。比较2组术后首次按压镇痛泵时间,术后1、12、24、48 h静息和咳嗽时的视觉模拟评分(visual analogue scale,VAS)及静脉血皮质醇浓度,术后舒芬太尼消耗量,以及不良反应的发生情况。结果 与R组比较,RD组患者的术后首次按压镇痛泵时间延长(P<0.05),术后舒芬太尼消耗量降低(P<0.05);RD组静息和咳嗽状态下术后1、12、24 h的VAS均低于同状态同时间点R组(P<0.05);RD组术后1、12、24 h皮质醇水平均低于同时间点R组(P<0.05),2组患者术后48 h皮质醇水平比较差异无统计学意义(P>0.05)。结论 罗哌卡因复合右美托咪定较单用罗哌卡因竖脊肌平面阻滞可延长胸腔镜肺叶切除手术患者术后镇痛持续时间,强化镇痛效果,降低术后应激激素的释放。Objective To study the impact of ultrasound-guided erector spinae plane block with ropivacaine combined with dexmedetomidine on postoperative stress and analgesia in patients undergoing thoracoscopic lobectomy.Methods Sixty patients who underwent thoracoscopic lobectomy under general anesthesia were selected and randomly divided into Group R(30 cases,erector spinae plane block with 30 mL of 0.5%ropivacaine)and Group RD(30 cases,erector spinae plane block with 30 mL of 0.5%ropivacaine plus 1μg·kg^(-1) dexmedetomidine).The time of the first analgesic pump compression after surgery,the visual analog scale(VAS)during rest and coughing at 1,12,24 and 48 hours after operation,the venous blood cortisol concentrations,postoperative sufentanil consumption,and the occurrence of adverse reactions were compared between the 2 groups.Results Compared with Group R,Group RD had a longer time for the first analgesia pump compression after surgery(P<0.05)and a lower consumption of sufentanil postoperatively(P<0.05).The VAS of patients in Group RD were lower than those in Group R during rest and coughing at 1,12 and 24 hours after operation(P<0.05).The cortisol levels of patients in Group RD were lower than those in Group R at 1,12 and 24 hours after operation(P<0.05),but there was no significant difference in cortisol levels between the 2 groups at 48 hours postoperatively(P>0.05).Conclusion Compared with erector spinae plane block with ropivacaine alone,the combination of ropivacaine and dexmedetomidine can prolong the duration of postoperative analgesia,enhance the analgesic effect,and reduce the release of postoperative stress hormones in patients undergoing thoracoscopic lobectomy.

关 键 词：右美托咪定 竖脊肌平面阻滞 胸腔镜手术 应激激素 镇痛 

分 类 号：R971[医药卫生—药品]