| 刘媛媛,刘福垒.右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析[J].安徽医药,2016,20(10):1940-1943. |
| 右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析 |
| Postoperative analgesia effect of dexmedetomidine combined with TPVB applied to open thoracic radical surgery of esophageal cancer |
| 投稿时间：2016-07-17 |
| DOI： |
| 中文关键词: 右美托咪定 罗哌卡因 胸椎旁神经阻滞 开胸术 镇痛 |
| 英文关键词: Dexmedetomidine Ropivacaine Thoracic paravertebral nerve block Horacotomy Analgesia |
| 基金项目:山东省自然科学基金(ZR2014HL108)右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析刘媛媛1,刘福垒2 (1.新矿集团中心医院药剂科,山东 泰安 271219；2.泰安市中心医院,山东 泰安 271219)右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析刘媛媛,刘福垒 |
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| 中文摘要: |
| 目的 探讨右美托咪定联合胸椎旁神经阻滞(TPVB)应用于开胸食管癌根治术对术后镇痛的影响。方法 102例行开胸食管癌根治术患者按随机数字表法分为联合组和单用组,每组51例,麻醉诱导前,两组患者均行超声引导下TPVB,联合组给予含0.75 μg·kg-1右美托咪定的0.5%罗哌卡因20 mL,单用组给予0.5%罗哌卡因20 mL,30 min后行全麻诱导。术后镇痛:两组患者均于手术结束时行椎旁自控镇痛,泵内含0.5%罗哌卡因100 mL,联合组同时使用微量注射泵泵入右美托咪定0.1 μg·kg-1·h-1。分别于首次TPVB前(T0)、给药后30 min(T1)、气管插管后(T2)、切皮(T3)、肿块切除(T4)时,记录两组患者平均动脉压(MAP)、心率(HR)、脑电双频谱指数(BIS)、血氧饱和度(SpO2),分别于术后2 h(T5)、6 h(T6)、12 h(T7)、24 h(T8)和48 h(T9)时,利用视觉模拟评分法(VAS)评分系统对患者疼痛进行评分,记录两组患者术后24 h内吗啡追加次数、咪达唑仑追加次数,以及不良反应发生情况。结果 与T0时相比,联合组MAP在T1～4时先降低后升高,HR在T1时降低,BIS在T1～4时降低,单用组MAP和HR在T2～4时升高,与单用组相比,联合组MAP和HR在T1～4时降低,BIS在T1～2时降低,SpO2在T3时升高,差异有统计学意义(P<0.05)；联合组患者T5～9时VAS评分均低于单用组,差异有统计学意义(P<0.05)；联合组患者术后24 h内吗啡追加次数和咪达唑仑追加次数均少于单用组,联合组患者术后总不良反应发生率低于单用组,差异有统计学意义(P<0.05)。结论 右美托咪定联合罗哌卡因行TPVB应用于开胸食管癌根治术可显著提高麻醉质量,改善术后镇痛效果,减少不良反应的发生。 |
| 英文摘要: |
| Objective To investigate the postoperative analgesia effect of dexmedetomidine combined with thoracic paravertebral nerve block (TPVB) applied to open thoracic radical surgery of esophageal cancer.Methods Totally 102 cases of patients undergoing elective open thoracic radical surgery were randomized into combined group (n=51) and monotherapy group (n=51).Before induction of anesthesia,two groups of patients underwent ultrasound-guided TPVB.Patients in the combined group were given 0.5% ropivacaine 20mL,which contained 0.75 μg·kg-1 dexmedetomidine,while patients in the monotherapy group were given 0.5% ropivacaine 20 mL.Both two groups received general anesthesia after the injection for 30 min.As for postoperative analgesia,patients in both groups received postoperative patient controlled intravenous analgesia.There was 100mL 0.5% ropivacaine in the pump,at the same time,patients in the combined group had 0.1 μg·kg-1·h-1 dexmedetomidine by using micro-injection pump.Before the first TPVB (T0),after administration 30 min (T1),after intubation (T2),skin incision (T3),excision (T4),respectively,the MAP,HR,BIS and SpO2 in the two groups were recorded.After surgery 2 h (T5),6 h (T6),12 h (T7),24 h (T8) and 48 h (T9),the scores of pains were evaluated by using the VAS scoring system.The morphin supplementation times,midazolam supplementation times within 24h,as well as adverse events were recorded.Results Compared with T0,in combined group,MAP at T1～4 were decreased at first and increased than,HR at T1 was reduced,BIS at T1～4 were decreased.In monotherapy group,MAP and HR at T2～4 were increased.Compared with the monotherapy group,MAP and HR in combined group at T1~4 were decreased,BIS at T1~2 were decreased,and SpO2 at T3 was increased.The differences were statistically significant(P<0.05).The VAS scores at T5~9 in combined group were lower than the monotherapy group.The differences were statistically significant (P<0.05).The morphin supplementation times and midazolam supplementation times within 24h in combined group were less than the monotherapy group.The overall incidence of adverse reactions in combined group was lower than the monotherapy group.The differences were statistically significant(P<0.05).Conclusions Dexmedetomidine combined with ropivacaine TPVB applied to open thoracic radical surgery of esophageal cancer could significantly improve the quality of anesthesia,improve postoperative analgesia and reduce the incidence of adverse reactions. |
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