超声引导下右美托咪定复合罗哌卡因胸椎旁阻滞用于开放肝脏手术术后镇痛的效果
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摘要
目的探讨超声引导下右美托咪定复合罗哌卡因胸椎旁阻滞对开放肝脏手术术后镇痛的影响。方法选取2016年1月—2017年1月蚌埠医学院第一附属医院择期施行的右侧肋缘下切口开腹肝脏手术患者40例,美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,随机分为2组。D组(右美托咪定组)使用含有右美托咪定1μg/kg的0.5%罗哌卡因20 ml,在超声引导下行胸椎旁阻滞,C组(对照组)相同方法给予0.5%罗哌卡因20 ml。记录2组患者全麻诱导前,气管插管后即刻,手术开始即刻,手术开始后30 min,手术结束时的平均动脉压和心率。2组患者苏醒拔管后即刻,术后4、12、24、48 h的静息VAS和轻微活动的VAS评分及Ramsay镇静评分,并记录术后PCIA按压补救镇痛的例数及不良反应发生情况。结果在拔管后即刻,D组的Ramsay镇静评分明显高于C组(P<0.05),静息VAS和轻微活动的VAS评分与C组比较差异无统计学意义(P>0.05)。在术后4、12、24 h,D组的静息VAS和轻微活动的VAS评分明显低于C组(P<0.05),而Ramsay镇静评分明显高于C组(P<0.05)。D组患者第1天需PCIA按压补救镇痛的例数明显低于C组(P<0.05)。2组患者在麻醉中各时刻的MAP和HR差异无统计学意义。2组患者术后均无明显不良反应发生。结论 1μg/kg右美托咪定复合0.5%罗哌卡因20 ml可以明显改善胸椎旁神经阻滞效果,延长作用时间,可安全用于开腹肝脏手术。
Objective To investigate the effect of ultrasound-guided thoracic paravertebral block with dexmedetomidine and ropivacaine on postoperative analgesia in open liver surgery. Methods Total 40 patients with ASA Ⅰ to Ⅱ in our hospital between January,2016 and January,2017 were randomly divided into two groups. In group D,0. 5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine were injected into thoracic paravertebral space guided by ultrasound. In group C,0. 5% ropivacaine were injected into thoracic paravertebral space. The mean arterial pressure( MAP) and heart rate were recorded before the induction of general anesthesia,immediate after the tracheal intubation,the beginning of the operation,30 minutes after the operation and the end of the operation. The visual analogue scale( VAS) of pain at rest and physical activity state and the Ramsay scores were recorded immediate after extubation,4 h after operation,12 h after operation,24 h after operation,and 48 h after operation. The effective pressing numbers and the adverse reactions were recorded. Results Immediate after the extubation,the Ramsay scores of group D was significantly higher than that in the group C; there was no significant difference in the VAS of pain at rest or physical activity state between the two groups.Four,twelve and twenty-four hours after the operation,the Ramsay scores of group D was significantly higher than those in the group C,and the VAS of pain at rest and physical activity state was significantly lower than that in the group C.There was no significant difference in MAP and HR between the two groups at every time of anesthesia; there were no nausea and vomiting,respiratory depression and other adverse reactions in the two groups. Conclusion 0. 5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine can safely enhance the effect of thoracic paravertebral nerve block( TPVB)and prolong the duration of analgesia in open liver surgery.
Objective To investigate the effect of ultrasound-guided thoracic paravertebral block with dexmedetomidine and ropivacaine on postoperative analgesia in open liver surgery. Methods Total 40 patients with ASA Ⅰ to Ⅱ in our hospital between January,2016 and January,2017 were randomly divided into two groups. In group D,0. 5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine were injected into thoracic paravertebral space guided by ultrasound. In group C,0. 5% ropivacaine were injected into thoracic paravertebral space. The mean arterial pressure( MAP) and heart rate were recorded before the induction of general anesthesia,immediate after the tracheal intubation,the beginning of the operation,30 minutes after the operation and the end of the operation. The visual analogue scale( VAS) of pain at rest and physical activity state and the Ramsay scores were recorded immediate after extubation,4 h after operation,12 h after operation,24 h after operation,and 48 h after operation. The effective pressing numbers and the adverse reactions were recorded. Results Immediate after the extubation,the Ramsay scores of group D was significantly higher than that in the group C; there was no significant difference in the VAS of pain at rest or physical activity state between the two groups.Four,twelve and twenty-four hours after the operation,the Ramsay scores of group D was significantly higher than those in the group C,and the VAS of pain at rest and physical activity state was significantly lower than that in the group C.There was no significant difference in MAP and HR between the two groups at every time of anesthesia; there were no nausea and vomiting,respiratory depression and other adverse reactions in the two groups. Conclusion 0. 5% ropivacaine 20 ml with 1 μg/kg dexmedetomidine can safely enhance the effect of thoracic paravertebral nerve block( TPVB)and prolong the duration of analgesia in open liver surgery.
引文
[1]张加强.超声引导下胸椎旁神经阻滞应用现状[J].中华实用诊断与治疗杂志,2017,31(2):111-112.
[2]Mohta M,Kalra B,Sethi AK,et al.Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery[J].J Anesth,2016,30(2):252-260.
[3]金耀君,赵璇.罗哌卡因复合右美托咪定对超声引导下腋路臂丛神经阻滞麻醉的影响[J].上海医学,2015,38(2):110-114.
[4]Salviz EA,Sivrikoz N,Ozonur A.et al.Ultrasound-guided bilateral thoracic paravertebral blocks as an adjunct to general anesthesia in patients undergoing reduction mammaplasty:a historical cohort study[J].Plast Reconstr Surg,2017,139(1):20e-28e.
[5]吕笑侠,陈祥明.椎旁神经阻滞的临床应用于进展[J].颈腰痛杂志,2016,37(3):250-252.
[6]何建华,马曙亮,顾连兵.超声引导椎旁神经阻滞在开胸手术中的应用[J].临床麻醉学杂志,2013,29(1):31-34.
[7]Li NL,Liu CC,Cheng SH,et al.Feasibility of combined paravertebral block and subcostal transversus abdominis plane block in postoperative pain control after minimally invasive esophagectomy[J].Acta Anaesthesiol Taiwan,2013,51(3):103-107.
[8]Abdallah FW,Morgan PJ,Cil T,et al.Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection[J].Anesthesiology,2014,120(3):703-713.
[9]Terawi AS,Tsang S,Sessler DI,et al.Improving analgesic efficacy and safety of thoracic paravertebral block for breast surgery:a mixed-effects meta-analysis[J].Pain Physician,2015,18(5):E757-E780.
[10]Bolin ED,Harvey NY,Willson SH.Regional anesthesia for breast surgery:techniques and benefits[J].Current Anesthesiology Reports,2015,5(2):217-224.
[11]孙乾伟,刘功俭.肝脏手术术后镇痛治疗的研究进展[J].医学综述,2017,23(3):540-544.
[12]刘孝文,刘真,赵晶.阿片类药物呼吸抑制作用的机制研究进展[J].基础医学与临床,2017,37(3):422-426.
[13]庆淑梅,曹亚楠,孙振涛.椎旁神经阻滞用于开胸手术老年患者超前镇痛效果[J].中华麻醉学杂志,2016,36(2):168-170.
[14]Ding X,Jin S,Niu X,et al.A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy:an updated meta-analysis[J].PLo S One,2014,9(5):e96233.
[15]郭强,高晓猛,吴婧.连续椎旁阻滞联合臭氧注射治疗老年人带状疱疹神经痛的安全性及临床疗效[J].实用老年医学,2017,31(7):620-622.
[16]Marhotra RK,Johnstone C,Banerjee A.Dexmedetomidine in peripheral and neuraxial block:a meta-analysis[J].Br J Anaesth,2014,112(2):390-391.
[17]肖萍,李亚楠,胡翠月,等.右美托咪定局部用药对罗哌卡因椎旁神经阻滞半数有效浓度的影响[J].中华麻醉学杂志,2015,35(5):587-589.
[18]彭捷,贾济,吴友平,等.不同剂量右美托咪定混合罗哌卡因椎旁阻滞在开胸术后的镇痛效果[J].中国新药与临床杂志,2017,36(2):101-104.
[19]Marhofer D,Kettner SC,Marhofer P,et al.Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J].Br J,Anaesth,2013,110(3):438-442.
[2]Mohta M,Kalra B,Sethi AK,et al.Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery[J].J Anesth,2016,30(2):252-260.
[3]金耀君,赵璇.罗哌卡因复合右美托咪定对超声引导下腋路臂丛神经阻滞麻醉的影响[J].上海医学,2015,38(2):110-114.
[4]Salviz EA,Sivrikoz N,Ozonur A.et al.Ultrasound-guided bilateral thoracic paravertebral blocks as an adjunct to general anesthesia in patients undergoing reduction mammaplasty:a historical cohort study[J].Plast Reconstr Surg,2017,139(1):20e-28e.
[5]吕笑侠,陈祥明.椎旁神经阻滞的临床应用于进展[J].颈腰痛杂志,2016,37(3):250-252.
[6]何建华,马曙亮,顾连兵.超声引导椎旁神经阻滞在开胸手术中的应用[J].临床麻醉学杂志,2013,29(1):31-34.
[7]Li NL,Liu CC,Cheng SH,et al.Feasibility of combined paravertebral block and subcostal transversus abdominis plane block in postoperative pain control after minimally invasive esophagectomy[J].Acta Anaesthesiol Taiwan,2013,51(3):103-107.
[8]Abdallah FW,Morgan PJ,Cil T,et al.Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection[J].Anesthesiology,2014,120(3):703-713.
[9]Terawi AS,Tsang S,Sessler DI,et al.Improving analgesic efficacy and safety of thoracic paravertebral block for breast surgery:a mixed-effects meta-analysis[J].Pain Physician,2015,18(5):E757-E780.
[10]Bolin ED,Harvey NY,Willson SH.Regional anesthesia for breast surgery:techniques and benefits[J].Current Anesthesiology Reports,2015,5(2):217-224.
[11]孙乾伟,刘功俭.肝脏手术术后镇痛治疗的研究进展[J].医学综述,2017,23(3):540-544.
[12]刘孝文,刘真,赵晶.阿片类药物呼吸抑制作用的机制研究进展[J].基础医学与临床,2017,37(3):422-426.
[13]庆淑梅,曹亚楠,孙振涛.椎旁神经阻滞用于开胸手术老年患者超前镇痛效果[J].中华麻醉学杂志,2016,36(2):168-170.
[14]Ding X,Jin S,Niu X,et al.A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy:an updated meta-analysis[J].PLo S One,2014,9(5):e96233.
[15]郭强,高晓猛,吴婧.连续椎旁阻滞联合臭氧注射治疗老年人带状疱疹神经痛的安全性及临床疗效[J].实用老年医学,2017,31(7):620-622.
[16]Marhotra RK,Johnstone C,Banerjee A.Dexmedetomidine in peripheral and neuraxial block:a meta-analysis[J].Br J Anaesth,2014,112(2):390-391.
[17]肖萍,李亚楠,胡翠月,等.右美托咪定局部用药对罗哌卡因椎旁神经阻滞半数有效浓度的影响[J].中华麻醉学杂志,2015,35(5):587-589.
[18]彭捷,贾济,吴友平,等.不同剂量右美托咪定混合罗哌卡因椎旁阻滞在开胸术后的镇痛效果[J].中国新药与临床杂志,2017,36(2):101-104.
[19]Marhofer D,Kettner SC,Marhofer P,et al.Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J].Br J,Anaesth,2013,110(3):438-442.