右美托咪定联合罗哌卡因行胸椎旁神经阻滞对胸腔镜下肺叶切除术的老年患者术后镇痛的影响

Postoperative analgesic effect of thoracic paravertebral blocks using a combination of dexmedetomidine and ropivacaine in elderly patients after thoracoscopic lobectomy

关键词:  右美托咪定  罗哌卡因  胸椎旁神经阻滞  肺叶切除术  术后镇痛

Key words:  dexmedetomidine  ropivacaine  thoracic paravertebral nerve block  pulmonary lobectomy  postoperative analgesia

摘要:

目的 研究右美托咪定联合罗哌卡因行胸椎旁神经阻滞（thoracic paravertebral block，TPVB）对行胸腔镜下肺叶切除术老年患者术后镇痛的影响。方法 将200例行胸腔镜下肺叶切除术老年患者按术后镇痛方法和药物的不同分为4组：S0、S1、S2、S3组；S0、S1组分别实施连续静脉自控镇痛（PCIA）与连续硬膜外自控镇痛（PCEA），S2、S3组实施连续TPVB自控镇痛（其中S2组应用右美托咪定联合罗哌卡因，S3组单独应用罗哌卡因）。比较S0，S1，S2，S3组患者术后疼痛阈值；S2，S3组阻滞起效与维持时间，观察纪录S2，S3组拔管后0 min （T0）、10 min （T1）、20 min （T2）、30 min （T3）、40 min （T4）、50 min （T5）、60 min （T6）的血氧饱和度（SpO₂），呼吸频率，心率（HR），平均动脉压（MAP）及4组的不良反应。结果 各组患者术前1天疼痛阈值差异无统计学意义（P>0.05），术后24 h和48 h，S1、S2、S3组与S0组患者相比疼痛阈值差异均有统计学意义（P<0.01）；S2组发生不良反应的情况较S0、S1组明显减少；同时S2组的阻滞起效时间比S3组的短，且维持时间长（P<0.05）。在T1-T6时S2组的HR、MAP较T0时降低（P<0.05），与S3组同时刻相比，2项指标均有所降低（P<0.05）。S2组除有5例（10.0%）发生心动过缓外，其不良反应发生情况明显较其他3组低。结论 应用右美托咪定联合罗哌卡因对行胸腔镜下行肺叶切除术的老年患者进行TPVB镇痛效果好，不良反应较少，安全性高。

Abstract:

Objective To explore the postoperative analgesic effect of thoracic paravertebral blocks using a combination of dexmedetomidine and ropivacaine in elderly patients after thoracoscopic lobectomy. Methods According to the postoperative analgesic method and drugs, 200 elderly patients, who underwent thoracoscopic lobectomy, were randomly selected and divided into 4 groups:S0, S1, S2, and S3. PCIA and PCEA were performed in S0 and S1 groups. TPNB was performed in S2 and S3 groups (S2 group received a combination of dexmedetomidine and ropivacaine, S3 group received ropivacaine alone). The postoperative pain threshold was compared among groups. The onset time and the maintenance time of sensory and motor in S2 and S3 groups of patients were recorded.The SpO₂, respiratory frequency, HR, MAP and adverse reactions in S2 and S3 groups of patients were observed and compared at the time of 0 min(T0), 10 min(T1), 20 min (T2), 30 min(T3), 40 min(T4), 50 min(T5), 60 min(T6) after block.Results One day before surgery, there was no significant difference in pain threshold in each group(P>0.05); there was significant difference in pain threshold between groups S1,S2,S3 and S0 at 24 h and 48 h after operation(P<0.01). Postoperative adverse reactions in the group S2 were significantly better than those in the S0 and S1 groups; the onset time of the group S2 was shorter than that of the group S3, the maintenance time was longer at the same time (P<0.05). Compared with T0, the levels of HR, MAP at T1-T6 were significantly lower in group S2, and the levels of HR, MAP of group S2 at T1-T6 were lower than those of group S3 (P<0.05). Except bradycardia in 5 patients (10.0%) of group S2, its postoperative adverse reactions were significantly better than others. Conclusion Dexmedetomidine combined with ropivacaine for thoracic paravertebral block on postoperative analgesia in elderly patients after thoracoscopic lobectomy can significantly enhance the effect of analgesia and high safety.