不同剂量右美托咪定复合罗哌卡因胸椎旁神经阻滞在非插管胸腔镜手术中的比较
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摘要
目的比较不同剂量右美托咪定复合罗哌卡因胸椎旁神经阻滞在非插管胸腔镜手术中的效果。方法择期行胸腔镜肺大泡切除术的患者114例,男90例,女24例,年龄25～60岁,BMI<25 kg/m~2,ASAⅠ或Ⅱ级,随机分为四组。麻醉诱导前行胸椎旁神经阻滞,C组注入0.375%罗哌卡因20 ml, D1、D2、D3组分别注入右美托咪定0.5、1.0、2.0μg/kg复合0.375%罗哌卡因20 ml。记录感觉阻滞起效时间和持续时间;入室时(T_0)、注药后30 min(T_1)、手术开始时(T_2)、手术开始后30 min(T_3)的RR、PaO_2和PaCO_2;术毕全麻药的用量;术中低血压、心动过缓和使用麻黄碱与阿托品的情况。结果与C、D1组比较,D2、D3组感觉阻滞起效时间明显缩短(P<0.05),持续时间明显延长(P<0.05),T_2、T_3时PaCO_2明显降低(P<0.05),RR、PaO_2明显升高(P<0.05),术毕丙泊酚和瑞芬太尼的用量明显减少(P<0.05);D3组心动过缓和低血压的发生率明显高于其他三组(P<0.05)。结论右美托咪定1.0μg/kg复合罗哌卡因行胸椎旁神经阻滞可缩短感觉阻滞起效时间,延长持续时间,减少全麻药用量,无明显血流动力学不良反应发生。
Objective To observe the efficacies of thoracic paravertebral block with different doses of dexmedetomidine and ropivacaine in non-intubation thoracoscopic surgery. Methods A total of 114 patients undergoing selective day thoracoscopic alveolectomy were randomly individed into four groups with 30 patients in each group. In groups D1, D2, D3, 0.375% ropivacaine 20 ml with 0.5 μg/kg, 1.0 μg/kg, 2.0 μg/kg dexmedetomidine were separately administrated to perform thoracic paravertebral nerve block, 0.375% ropivacaine 20 ml were administrated to group C. RR, PaO_2 and PaCO_2 were recorded at the moment of in operating room(T_0), 30 minutes after thoracic paravertebral block(T_1), beginning of operation(T_2), 30 min after operation begining(T_3). The dosage of propofol and remifentanil、incidence of hypotension and bradycardia, sensory block onset time and blockade durations were also recorded.Results Compared with groups C and D1, sensory block onset time was shorter and blockade duration was longer(P<0.05), PaCO_2 decreased and RR, PaO_2 were higher at T_2 and T_3(P<0.05), the dosage of propofol and remifentanil decreased(P<0.05)in groups D2 and D3. The incidence of hypotension and bradycardia was higher in group D3 than in other groups(P<0.05). Conclusion dexmedetomidine 1.0 μg/kg in combination with ropivacaine for thoracic paravertebral block can shorten sensory block onset time and prolong the duration of sensory blockade, reduce the amount of anesthetics, maintain hemodynamic stability.
Objective To observe the efficacies of thoracic paravertebral block with different doses of dexmedetomidine and ropivacaine in non-intubation thoracoscopic surgery. Methods A total of 114 patients undergoing selective day thoracoscopic alveolectomy were randomly individed into four groups with 30 patients in each group. In groups D1, D2, D3, 0.375% ropivacaine 20 ml with 0.5 μg/kg, 1.0 μg/kg, 2.0 μg/kg dexmedetomidine were separately administrated to perform thoracic paravertebral nerve block, 0.375% ropivacaine 20 ml were administrated to group C. RR, PaO_2 and PaCO_2 were recorded at the moment of in operating room(T_0), 30 minutes after thoracic paravertebral block(T_1), beginning of operation(T_2), 30 min after operation begining(T_3). The dosage of propofol and remifentanil、incidence of hypotension and bradycardia, sensory block onset time and blockade durations were also recorded.Results Compared with groups C and D1, sensory block onset time was shorter and blockade duration was longer(P<0.05), PaCO_2 decreased and RR, PaO_2 were higher at T_2 and T_3(P<0.05), the dosage of propofol and remifentanil decreased(P<0.05)in groups D2 and D3. The incidence of hypotension and bradycardia was higher in group D3 than in other groups(P<0.05). Conclusion dexmedetomidine 1.0 μg/kg in combination with ropivacaine for thoracic paravertebral block can shorten sensory block onset time and prolong the duration of sensory blockade, reduce the amount of anesthetics, maintain hemodynamic stability.
引文
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[3] 余露,盛良,杭东元.不同剂量右美托咪定对罗哌卡因肋间神经阻滞效果的影响.临床麻醉学杂志,2016,32(12):1217-1218.
[4] 刘月江,王臻,景亮.地塞米松对0.5%罗哌卡因腰丛-坐骨神经联合阻滞作用的影响.临床麻醉学杂志,2010,26(2):104-106.
[5] 项明方,姚达,方光光.491例全麻下肺切除术患者围术期并发症与体质指数关系的回顾性分析.岭南现代临床外科,2017,17(3):333-336.
[6] 代思吉,苏子敏,薛张纲.右美托咪定托咪定在围术期的研究进展.国际麻醉学与复苏杂志,2015,36(1):61-64.
[7] Jin S,Liang DD,Chen C,et al.exmedetomidine preventpostoperative nausea and vomiting on patients during general anesthesia:a PRISMA-compliant meta analysis of randomized controlled trials.Medicine(Baltimore),2017,96(1):e5770.
[8] Joana A,Flavio R.Dexmedetomidine:current role in anesthesia and intensive cara.Rev Bras Anestesiol,2012,62(1):118-133.
[9] Raof RA,El Metainy SA,Alia DA,et al.Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients:a rand omized study.J Clin Anesth,2017,37(1):55- 60.
[10] 胡光俊,宋晓阳,陶军.罗哌卡因复合右美托咪定对臂丛神经阻滞的影响.临床麻醉学杂志,2014,30(6):546-549.
[11] 侯源源,闻庆平.右美托咪定应用于椎管内麻醉的研究进展.国际麻醉学与复苏杂志,2014,35(8):735-738.
[12] 杨颖聪,陈向东,夏中元.脊髓HCN通道在右美托咪定抗伤害效应中的用:在体和离体实验.中华麻醉学杂志,2015,35(9):1096-1100.
[13] El-Boghdadly K,Brull R,Sehmbi H.Perineural dexmeditomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block:a systematic review and meta-analysis.Reg Anesth Pain Med,2017,124(6):2008-2020.
[2] Das A,Dutta S,Chattopadhyay S,et al.Pain relief after ambulatory hand surgery:a comparison between dexmedetomidine and clonidine as adjuvant in axillary brachial plexus block:a prospective,double-blinded,randomized controlled study.Saudi J Anaesth,2016,10(1):6-12.
[3] 余露,盛良,杭东元.不同剂量右美托咪定对罗哌卡因肋间神经阻滞效果的影响.临床麻醉学杂志,2016,32(12):1217-1218.
[4] 刘月江,王臻,景亮.地塞米松对0.5%罗哌卡因腰丛-坐骨神经联合阻滞作用的影响.临床麻醉学杂志,2010,26(2):104-106.
[5] 项明方,姚达,方光光.491例全麻下肺切除术患者围术期并发症与体质指数关系的回顾性分析.岭南现代临床外科,2017,17(3):333-336.
[6] 代思吉,苏子敏,薛张纲.右美托咪定托咪定在围术期的研究进展.国际麻醉学与复苏杂志,2015,36(1):61-64.
[7] Jin S,Liang DD,Chen C,et al.exmedetomidine preventpostoperative nausea and vomiting on patients during general anesthesia:a PRISMA-compliant meta analysis of randomized controlled trials.Medicine(Baltimore),2017,96(1):e5770.
[8] Joana A,Flavio R.Dexmedetomidine:current role in anesthesia and intensive cara.Rev Bras Anestesiol,2012,62(1):118-133.
[9] Raof RA,El Metainy SA,Alia DA,et al.Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients:a rand omized study.J Clin Anesth,2017,37(1):55- 60.
[10] 胡光俊,宋晓阳,陶军.罗哌卡因复合右美托咪定对臂丛神经阻滞的影响.临床麻醉学杂志,2014,30(6):546-549.
[11] 侯源源,闻庆平.右美托咪定应用于椎管内麻醉的研究进展.国际麻醉学与复苏杂志,2014,35(8):735-738.
[12] 杨颖聪,陈向东,夏中元.脊髓HCN通道在右美托咪定抗伤害效应中的用:在体和离体实验.中华麻醉学杂志,2015,35(9):1096-1100.
[13] El-Boghdadly K,Brull R,Sehmbi H.Perineural dexmeditomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block:a systematic review and meta-analysis.Reg Anesth Pain Med,2017,124(6):2008-2020.