右美托咪定混合罗哌卡因胸椎旁阻滞用于开胸手术患者围手术期镇痛管理的效果

Efficacy of dexmedetomidine applied with ropivacaine for thoracic paravertebral blockade in thoracotomy

目的 评价右美托咪定（dexmedetomidine,Dex）混合罗哌卡因胸椎旁阻滞（thoracic paravertebral nerve blockade,TPVB）用于开胸手术患者围手术期镇痛管理的效果.方法 择期全身麻醉下行开胸手术患者30例,采用随机数字表法分为2组：罗哌卡因用于胸椎旁连续阻滞组（TL组,15例）和Dex混合罗哌卡因用于胸椎旁连续阻滞组（TDL组,15例）.两组患者麻醉诱导前在超声引导下局部注射0.35％罗哌卡因30 ml或0.35％罗哌卡因与Dex 1μg/kg混合液30 ml进行TPVB.术后患者自控镇痛（patient controlled analgesia,PCA）方案：TL组方案为1％罗哌卡因50 ml用生理盐水稀释到250 ml,负荷剂量5 ml,背景输注速率5 ml/h,锁定时间15 min,剂量5 ml;TDL组方案为1％罗哌卡因50 ml与Dex 2μg/kg的混合液,生理盐水稀释到250 ml,参数设置与TL组相同;两组均镇痛至术后36 h.分别于术前1 d及术后12、24、48、72 h时点记录切口压痛阈,记录术中异丙酚和瑞芬太尼用量,记录围手术期镇痛有关不良事件的发生情况.结果 与TL组比较,TDL组术后24、48 h压痛阈与基础痛阈的差值升高（P〈0.05）,术中单位时间异丙酚[（251±13）mg/h比（211±18）mg/h]和瑞芬太尼[（0.49±0.05）mg/h比（0.42±0.04）mg/h]用量均降低（P〈0.05）.结论 Dex混合罗哌卡因可显著优化TPVB用于开胸手术患者围手术期镇痛管理的效果.

Objective To explore the analgesic efficacy of dexmedetomidine （Dex） applied with ropivacaine for thoracic paravertebral nerve blockade （TPVB） in thoracotomy. Methods Thirty patients undergoing thoracotomy were randomly divided into two groups（15 patients in each）. Patients in one group （ group TL） received 0.35%ropivacaine 30 ml for TPVB, while the other group （ group TDL） received 1μg/kg Dex added into 0.35%ropivacaine 30 ml for TPVB. Thoracic paravertebral patient-controlled analgesia （PCA） was carried out up till 36 h after surgery. The tenderness thresholds on 1 day before surgery, and 12, 24, 48 h and 72 h after surgery were recorded. The consumption of general anesthetics （propofol and remifentanil） during the surgery were also recorded. The incidence of side-effects related to analgesia in the first 3 d after surgery were analyzed. Results The tenderness threshold 24 h and 48 h after surgery in group TDL were significantly higher than in group TL （P〈0.05）. Additionally, the intraoperative consumption of Propofol[（251±13）mg/h vs（211±18）mg/h]and remifentanil[（0.49±0.05）mg/h vs （0.42±0.04）mg/h]were less than that in group TDL （P〈0.05）. Conclusions Application of Dex with ropivacaine for continuous TPVB in thoracotomy can relieve postoperative pain.