摘要
目的观察超声引导下罗哌卡因及罗哌卡因复合右美托咪定前锯肌阻滞(SAPB)在胸腔镜肺癌根治术的临床效果。方法选取2020年8月至2021年7月该院择期行胸腔镜肺癌根治术的128例患者为研究对象。采用随机数字表法分为罗哌卡因复合右美托咪定组(RD组)、罗哌卡因组(R组)和单纯全身麻醉组(C组)。RD组和R组麻醉诱导前均行SAPB,RD组术侧注射0.5%的罗哌卡因与0.5μg/kg的右美托咪定混合液20 mL,R组术侧注射0.5%的罗哌卡因20 mL。比较各组记录术中丙泊酚、瑞芬太尼用量,恢复室拔管时长、苏醒延迟及苏醒期躁动,术中心动过缓的发生情况,术后4、8、12、24、48 h静息及活动疼痛视觉模拟评分(VAS),术后24 h舒芬太尼用量、补救镇痛和恶心呕吐发生情况,术前1 d和术后1 d睡眠时间、术后首次下床活动时间。结果与C组比较,RD组和R组术中丙泊酚和瑞芬太尼用量明显减少,拔管时长缩短,苏醒延迟和苏醒躁动发生率明显降低,差异有统计学意义(P<0.05)。术后4 h,RD组和R组静息及活动VAS明显低于C组,术后8、12、24 h RD组静息及活动VAS低于R组和C组(P<0.05)。与R组和C组比较,RD组舒芬太尼用量明显减少,恶心呕吐发生率明显降低(P<0.05)。术后0~<8 h RD组和R组补救镇痛率低于C组,术后8~<24 h RD组补救镇痛率低于R组和C组(P<0.05)。3组术前1 d睡眠时间无差异(P>0.05)。R组和C组术后1 d睡眠时间较术前1 d缩短,RD组术后1 d睡眠时间较R组和C组明显增加,而术后首次下床活动时间明显缩短(P<0.05)。结论超声引导下0.5%罗哌卡因SAPB可安全、有效用于胸腔镜肺癌根治术镇痛。添加0.5μg/kg的右美托咪定可延长阻滞时间,减轻术后疼痛,促进术后康复。
Objective To observe the clinical effect of ropivacaine and ropivacaine combined with dexmedetomidine for serratus anterior plane block(SAPB)guided by ultrasound in people underwent thoracoscopic radical resection of lung cancer.Methods A total of 128 patients who underwent elective thoracoscopic radical lung cancer surgery in this hospital from August 2020 to July 2021 were selected for the study.A random number table was used to divide the patients into ropivacaine combined with dexmedetomidine group(RD group),ropivacaine group(R group)and general anesthesia alone group(C group).SAPB was performed before induction of anesthesia in both RD and R groups,and 20 mL of a mixture of 0.5% ropivacaine and 0.5μg/kg dexmedetomidine was injected on the operative side in RD group and 20 mL of 0.5% ropivacaine was injected on the operative side in R group.Compared intraoperative propofol and remifentanil dosages,the length of extubation in the recovery room,the delay in awakening and the occurrence of agitation during the awakening period,the occurrence of bradycardia,resting and activity visual analogue scores(VAS)at 4,8,12,24 and 48 h post-operatively,the amount of sufentanil used,the occurrence of remedial analgesia and nausea and vomiting at 24 h postoperatively,the duration of sleep 1 d before and 1 d after surgery,and the time of first postoperative bed activity.Results Compared with C group,intraoperative propofol and remifentanil dosage was significantly reduced in RD and R groups.The duration of extubation was shortened,and the incidence of delayed awakening and awakening agitation was significantly reduced,and the difference was statistically significant(P<0.05).At 4 h postoperatively,the resting and active VAS was significantly lower in RD and R groups than in group C,and at 8,12 and 24 h postoperatively the resting and active VAS was lower in RD group than in R and C groups(P<0.05).Compared with R and C group,RD group had significantly lower sufentanil dosage and a significantly lower incidence of nausea and vomiting(P<0.05).The rate of remedial analgesia was lower in RD and R groups than in C group from 0 to less than 8 h postoperatively,and lower in RD group than in R and C groups from 8 to less than 24 h postoperatively(P<0.05).There was no difference in sleep time in the 3 groups 1 d before surgery(P>0.05).The time to first postoperative bed activity was significantly shorter(P<0.05).Conclusion Ultrasound-guided 0.5%ropivacaine SAPB can be used safely and effectively for analgesia in thoracoscopic radical lung cancer surgery.The addition of 0.5μg/kg of dexmedetomidine can prolong the block time,reduce postoperative pain and promote postoperative recovery.
作者
董麦娟
严军
赵莎
邢静瑶
王强
DONG Maijuan;YAN Jun;ZHAO Sha;XING Jingyao;WANG Qiang(Department of Anesthesiology,the First Affiliated Hospital of Medical College of Xi’an Jiaotong University,Xi’an,Shaanxi 710061,China)
出处
《重庆医学》
CAS
2022年第18期3105-3110,共6页
Chongqing medicine
基金
国家自然科学基金项目(81974540)
陕西省自然科学基础研究计划项目(2017JZ029)。
关键词
前锯肌平面阻滞
罗哌卡因
佐剂
右美托咪定
胸腔镜手术
serratus anterior plane block
ropivacaine
adjuvant
dexmedetomidine
thoracoscopic surgery
作者简介
董麦娟(1989-),住院医师,硕士,主要从事围术期疼痛管理与神经阻滞研究;通信作者:王强,E-mail:dr.wangqiang@139.com。
