非插管胸腔镜围术期应用罗哌卡因多囊脂质体的疗效观察

Application and effect of multivesicular liposomal ropivacaine in non-intubated thoracoscopy surgery

目的非插管胸腔镜术中应用罗哌卡因多囊脂质体,观察围术期并发症情况,判断其疗效。方法选取2016年1—9月非插管胸腔镜手术患者60例,随机数字表法分为A组(0.2%罗哌卡因),B组(0.2%罗哌卡因多囊脂质体),C组(0.1%罗哌卡因联合0.4μg/ml舒芬太尼),每组20例。术前于T6~7行硬膜外穿刺置管,2 mg吗啡镇痛,术中由丙泊酚和右美托咪定联合泵注经面罩自主呼吸,观察3组患者术中呼吸循环变化,记录术后1、4、8、24 h患者VAS疼痛评分、术中呛咳、低氧血症和高碳酸血症、术后恶心呕吐等并发症。采用复乳化法,以0.2%罗哌卡因、磷脂、三油酸甘油酯、胆固醇、L-赖氨酸为原料制备罗哌卡因多囊脂质体;罗哌卡因脂质体为圆球形,内部呈多囊泡结构,粒径为7~30μm,平均粒径为(15.36±7.87)μm;药物释放时间为6 h释放65.0%,24 h释放90%,48~60 h释放完毕。结果术中血压方面,A组与B组、C组相比差异有统计学意义(P<0.05)。呼吸频率方面,A组和B组在人工气胸时和人工气胸后30 min呼吸频率低于C组(P<0.05);A组术后4、8 h呼吸频率高于B、C组(P<0.05)。并发症方面,A组术中恶心呕吐及并发症发生率高于B组(P<0.05)。静息和咳嗽疼痛VAS评分方面,B组术后4、8 h静息和咳嗽疼痛VAS评分低于A、C组(P<0.05)。结论罗哌卡因多囊脂质体能够减轻非插管胸腔镜围术期并发症,可实现麻醉药物的定点定量精确释放,具有持续释放、定量释放等特点,值得临床推广使用。

Objective To investigate the application and effect of multivesicular liposomal ropivacaine in non-intubated thoracoscopy surgery and the incidence of perioperative complications. Methods A total of 60 patients undergoing nonintubated thoracoscopy surgery in our hospital between January,2016 to September,2016 were enrolled and randomly divided into group A（ 0. 2% ropivacaine）,group B（ 0. 2% ropivacaine and multivesicular liposomal ropivacaine） and group C（ 0. 1% ropivacaine and 0. 4 μg/ml sufentanil） with 20 cases in each group. Epidural catheter was placed at the T6-T7 level before the surgery,and 2 mg morphine was injected for analgesia. The propofol and dexmedetomidine were given by a infusion pump during the operation. The patients breathe independently via face mask. The changes of respiration and blood circulation were observed among the three groups. Postoperative VAS pain score at 1,4,8 and 24 hours after the operation were recorded. The complications such as intraoperative cough,hypoxemia,hypercapnia and postoperative nausea and vomiting were also recorded. The multivesicular liposomal ropivacaine was prepared with 0. 2% ropivacaine,phospholipid,cholesterol,three oleic acid glyceride and L-lysine as materials by multiple emulsion process. The multivesicular liposomal ropivacaine was a spherical body,its internal structure consisted of the polycystic bubble,the size was of 7-30μm,the average particle size was（ 15. 36 ± 7. 87） μm; The release rate of drug was 65% at 6 hours,90% at 24 hours,and complete within 48-60 hours. Results In terms of blood pressure in surgery,there was significant difference between group A compared with group B and group C（ P〈0. 05）. In terms of respiratory frequency,the respiratory rate of group A and group B were lower than that in group C when artificial pneumothorax and 30 minutes after artificial pneumothorax（ P〈0. 05）; In group A,4 and 8 hours after surgery were higher than those in group B and group C（ P〈0. 05）. In terms of complications,the incidence of nausea and vomiting in group A was higher than that in group B during surgery（ P〈0. 05）. In terms of the resting and cough pain VAS score,B group was lower than A and C group after surgery 4 and 8hours（ P〈0. 05）. Conclusion The multivesicular liposomal ropivacaine can reduce the perioperative complications of non-intubated thoracoscopy surgery and achieve accurate quantitative release of anesthetic drugs,and has the characteristics of sustained release and quantitative release,which is worthy of clinical application.