不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用

doi:10.11958/20220461

天津医药 ›› 2022, Vol. 50 ›› Issue (12): 1324-1329.doi: 10.11958/20220461

不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用

杨蓉蓉(), 徐兴国, 卞小翠, 黄新冲^△()

南通大学附属医院麻醉科（邮编226001）

收稿日期:2022-02-28 修回日期:2022-05-10 出版日期:2022-12-15 发布日期:2022-12-30
通讯作者: 黄新冲 E-mail:yangr_ongr@yeah.net;1069460433@qq.com
作者简介:杨蓉蓉（1985），女，副主任医师，主要从事神经阻滞麻醉、危重症麻醉方面研究。E-mail：yangr_ongr@yeah.net

Application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery

YANG Rongrong(), XU Xingguo, BIAN Xiaocui, HUANG Xinchong^△()

Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong 226001, China

Received:2022-02-28 Revised:2022-05-10 Published:2022-12-15 Online:2022-12-30
Contact: HUANG Xinchong E-mail:yangr_ongr@yeah.net;1069460433@qq.com

杨蓉蓉, 徐兴国, 卞小翠, 黄新冲. 不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用[J]. 天津医药, 2022, 50(12): 1324-1329.

YANG Rongrong, XU Xingguo, BIAN Xiaocui, HUANG Xinchong. Application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery[J]. Tianjin Medical Journal, 2022, 50(12): 1324-1329.

摘要/Abstract

摘要：

目的探讨不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用。方法选择157例择期胸外科手术患者进行胸椎旁神经阻滞，对照组（40例）给予0.375%罗哌卡因，低（39例）、中（40例）、高（38例）剂量组分别给予0.5、1.0、2.0 μg/kg右美托咪定及0.375%罗哌卡因。记录入室时（T₀）、麻醉诱导时（T₁）、手术开始时（T₂）、手术开始30 min（T₃）、术毕（T₄）的心率（HR）和平均动脉压（MAP）；术后不同时间静息、活动状态下疼痛视觉模拟评分（VAS）、肾上腺素、皮质醇（Cor）水平。结果中、高剂量组术中丙泊酚、瑞芬太尼用量及术后自控镇痛次数低于对照组和低剂量组，低剂量组术后自控镇痛次数低于对照组（P<0.05）；T₂时间点高剂量组HR、MAP低于其他3组，T₃时间点高剂量组HR低于对照组和中剂量组（P<0.05）；与对照组、低剂量组比较，中、高剂量组术后12、24、48 h时静息及活动状态VAS评分、Cor均降低，术后12、24 h 肾上腺素降低；低剂量组术后24、48 h静息状态VAS评分、肾上腺素水平，术后12、48 h活动状态VAS评分，术后24 h Cor水平均低于对照组（P<0.05）；高剂量组术后12 h静息状态VAS评分低于中剂量组（P<0.05）。结论 1.0 μg/kg右美托咪定复合罗哌卡因行胸椎旁神经阻滞可提高术后镇痛效果，减少应激反应，对血流动力学影响较小。

关键词: 右美托咪定, 罗哌卡因, 胸椎旁神经阻滞, 外科手术

Abstract:

Objective To investigate the application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery. Methods Thoracic paravertebral block was performed in 157 patients underging elective thoracic surgery. Patients were divided into the four groups. The control group (n=40) was treated with 0.375% ropivacaine, while patients in the low-dose group (n=39), middle-dose group (n=40) and high-dose group (n=38) were treated with 0.5 μg/kg, 1.0 μg/kg and 2.0 μg/kg of dexmedetomidine combined with 0.375% ropivacaine, respectively. Heart rate (HR) and mean arterial pressure (MAP) on entering the room (T₀), at anesthesia induction (T₁), at the beginning of surgery (T₂), at 30 minutes after the beginning of surgery (T₃) and at the end of surgery (T₄) were recorded. Visual Analogue Scale (VAS) scores in resting state and active state, levels of epinephrine and cortisol (Cor) at different time points after surgery were also recorded. Results The intraoperative dosages of propofol and remifentanil, and the times of postoperative patient-controlled analgesia used in the middle-dose group and the high-dose group were lower than those in the control group and the low-dose group, and the times of postoperative patient-controlled analgesia used in the low-dose group was less than that in the control group (P<0.05). HR and MAP at T₂were lower in the high-dose group than those of the other 3 groups. HR at T₃ was lower in the high-dose group than that of the control group and the middle-dose group (P<0.05). Compared with the control group and the low-dose group, the VAS and Cor scores at 12 h, 24 h and 48h after surgery and in resting state and active state were decreased in the middle-dose group and the high-dose group. Epinephrine was decreased at 12 h and 24 h after surgery. The VAS scores and epinephrine levels at 24 h and 48 h after surgery and in resting state, the VAS scores at 12 h and 48 h after surgery and in active state, and Cor level at 24 h after surgery were lower in the low-dose group than those in the control group. The VAS score in resting state at 12 h after surgery was lower in the high-dose group than that in the middle-dose group (P<0.05). Conclusion 1.0 μg/kg of dexmedetomidine combined with ropivacaine thoracic paravertebral block can improve postoperative analgesia effect, reduce stress response and have little influence on hemodynamics in patients undergoing thoracic surgery.

Key words: dexmedetomidine, ropivacaine, thoracic paravertebral block, surgery

中图分类号:

R614

图/表 5

参考文献 24

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组别	n	男性	年龄（岁）	BMI（kg/m²）
对照组	40	18（45.00）	61.80±9.92	22.76±1.46
低剂量组	39	17（43.59）	61.67±9.45	22.81±1.22
中剂量组	40	18（45.00）	58.23±11.74	22.74±1.41
高剂量组	38	16（42.11）	56.84±12.91	22.85±1.33
χ²或F		0.090	1.967	0.058

组别	n	男性	年龄（岁）	BMI（kg/m²）
对照组	40	18（45.00）	61.80±9.92	22.76±1.46
低剂量组	39	17（43.59）	61.67±9.45	22.81±1.22
中剂量组	40	18（45.00）	58.23±11.74	22.74±1.41
高剂量组	38	16（42.11）	56.84±12.91	22.85±1.33
χ²或F		0.090	1.967	0.058

组别	n	术中给药		术后自控镇痛次数（次）
组别	n	丙泊酚用量（mg）	瑞芬太尼用量（mg）	术后自控镇痛次数（次）
对照组	40	310.81±19.60	1.27±0.08	8.88±0.94
低剂量组	39	303.26±22.53	1.25±0.09	8.08±1.16^a
中剂量组	40	282.13±24.03^ab	1.19±0.11^ab	7.15±1.55^ab
高剂量组	38	285.74±27.91^ab	1.18±0.08^ab	7.13±1.47^ab
F		13.398^＊＊	8.566^＊＊	16.381^＊＊

组别	n	术中给药		术后自控镇痛次数（次）
组别	n	丙泊酚用量（mg）	瑞芬太尼用量（mg）	术后自控镇痛次数（次）
对照组	40	310.81±19.60	1.27±0.08	8.88±0.94
低剂量组	39	303.26±22.53	1.25±0.09	8.08±1.16^a
中剂量组	40	282.13±24.03^ab	1.19±0.11^ab	7.15±1.55^ab
高剂量组	38	285.74±27.91^ab	1.18±0.08^ab	7.13±1.47^ab
F		13.398^＊＊	8.566^＊＊	16.381^＊＊

组别	n	HR（次/min）					MAP（mmHg）
组别	n	T₀	T₁	T₂	T₃	T₄	T₀	T₁	T₂	T₃	T₄
对照组	40	76.33±8.33	72.73±9.09	76.43±8.06	77.75±8.40	76.58±7.92	77.45±5.32	78.60±6.92	79.00±6.94	78.50±5.68	78.58±4.72
低剂量组	39	75.49±7.47	75.33±8.15	74.59±9.37	75.49±8.57	75.67±7.40	77.36±7.16	78.59±3.48	78.69±4.49	78.67±6.96	79.23±5.78
中剂量组	40	77.65±8.04	74.40±8.38	76.75±8.44	76.83±9.18	77.55±7.19	78.48±6.00	80.30±5.75	80.85±5.45	81.05±5.47	80.65±4.54
高剂量组	38	75.74±8.29	74.74±7.80	69.50±7.75^abc	71.79±6.89^ac	77.63±7.38	78.00±5.97	78.18±6.80	72.13±4.63^abc	81.18±5.77	79.66±4.29
F		0.571	0.706	6.096^＊＊	3.833^＊	0.599	0.284	1.006	18.679^＊＊	2.345	1.278

不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用

Application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery

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组别	n	静息状态VAS					活动状态VAS
组别	n	术后1 h	术后6 h	术后12 h	术后24 h	术后48 h	术后1 h	术后6 h	术后12 h	术后24 h	术后48 h
对照组	40	2.10±0.44	2.03±0.36	2.85±0.62	3.03±0.62	3.10±0.50	2.40±0.50	2.58±0.50	3.53±0.51	3.43±0.50	3.68±0.53
低剂量组	39	2.10±0.38	2.10±0.50	2.85±0.49	2.62±0.63^a	2.72±0.51^a	2.44±0.50	2.72±0.46	3.26±0.50^a	3.28±0.51	2.92±0.48^a
中剂量组	40	2.08±0.35	2.03±0.36	2.35±0.48^ab	2.15±0.53^ab	1.93±0.42^ab	2.63±0.49	2.50±0.51	2.98±0.36^ab	2.63±0.49^ab	2.35±0.48^ab
高剂量组	38	2.16±0.37	2.11±0.51	2.05±0.23^abc	1.97±0.37^ab	1.74±0.45^ab	2.61±0.50	2.71±0.46	2.97±0.28^ab	2.66±0.48^ab	2.16±0.37^ab
F		0.314	0.428	26.027^＊＊	29.214^＊＊	74.568^＊＊	2.122	1.925	15.441^＊＊	27.670^＊＊	83.151^＊＊

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组别	n		肾上腺素（ng/L）
组别	n		T₀		T₃		术后12 h		术后24 h		术后48 h
对照组	40		42.86±8.39		42.20±7.67		56.21±8.51		74.74±21.76		87.88±19.01
低剂量组	39		40.83±8.86		42.56±7.41		61.82±19.26		59.20±20.43^a		64.80±18.10^a
中剂量组	40		44.62±9.28		44.32±7.44		47.78±15.03^ab		50.92±11.75^ab		58.65±14.42^a
高剂量组	38		41.76±8.91		41.79±8.30		43.22±9.37^ab		47.96±10.95^ab		60.94±10.66^a
F			1.335		0.837		14.244^＊＊		19.742^＊＊		28.326^＊＊
组别		Cor（nmol/L）
组别		T₀		T₃		术后12 h		术后24 h		术后48 h
对照组		331.09±49.32		308.35±45.43		434.44±60.67		558.11±88.35		471.05±83.16
低剂量组		324.77±59.42		320.87±44.07		419.88±85.20		497.76±67.53^a		491.25±76.50
中剂量组		320.17±48.05		312.04±39.17		374.24±66.68^ab		455.42±71.46^ab		407.00±68.37^ab
高剂量组		325.92±50.65		330.66±39.11		348.78±71.50^ab		438.74±77.68^ab		420.53±75.09^ab
F		0.297		2.177		12.052^＊＊		18.981^＊＊		10.979^＊＊

组别	n		肾上腺素（ng/L）
组别	n		T₀		T₃		术后12 h		术后24 h		术后48 h
对照组	40		42.86±8.39		42.20±7.67		56.21±8.51		74.74±21.76		87.88±19.01
低剂量组	39		40.83±8.86		42.56±7.41		61.82±19.26		59.20±20.43^a		64.80±18.10^a
中剂量组	40		44.62±9.28		44.32±7.44		47.78±15.03^ab		50.92±11.75^ab		58.65±14.42^a
高剂量组	38		41.76±8.91		41.79±8.30		43.22±9.37^ab		47.96±10.95^ab		60.94±10.66^a
F			1.335		0.837		14.244^＊＊		19.742^＊＊		28.326^＊＊
组别		Cor（nmol/L）
组别		T₀		T₃		术后12 h		术后24 h		术后48 h
对照组		331.09±49.32		308.35±45.43		434.44±60.67		558.11±88.35		471.05±83.16
低剂量组		324.77±59.42		320.87±44.07		419.88±85.20		497.76±67.53^a		491.25±76.50
中剂量组		320.17±48.05		312.04±39.17		374.24±66.68^ab		455.42±71.46^ab		407.00±68.37^ab
高剂量组		325.92±50.65		330.66±39.11		348.78±71.50^ab		438.74±77.68^ab		420.53±75.09^ab
F		0.297		2.177		12.052^＊＊		18.981^＊＊		10.979^＊＊