单点胸椎旁注射不同浓度罗哌卡因在胸腔镜下肺叶切除术中的应用

Application of single point thoracic paraspinal injection with different concentrations of ropivacaine in thoracoscopic lobectomy

目的:探讨B超引导下胸椎旁单点注射不同浓度罗哌卡因应用于胸腔镜下肺叶切除手术麻醉的镇痛效果及安全性。方法:选取我院2016年1月至2017年12月行胸腔镜下肺叶切除患者60例,随机分成3组,每组20例。低浓度组:0.375%罗哌卡因椎旁阻滞;中浓度组:0.5%罗哌卡因椎旁阻滞;高浓度组:0.75%罗哌卡因椎旁阻滞。术后常规PCIA。观察术后静息及咳嗽时NRS评分、不良反应;记录术中瑞芬太尼用量及血压和心率的变化,术后PCIA按压总次数;测定肺功能。结果:PCIA按压次数低浓度组明显多于中浓度组和高浓度组(P<0.05);与术前相比,高浓度组患者在术毕和术后30min的心率及血压明显降低(P<0.05),高浓度组在术毕和术后30min时较低浓度组和中浓度组的心率及血压明显降低(P<0.05);与低浓度组相比,中浓度组和高浓度组在术后6h的静息时NRS评分明显降低(P<0.05),中浓度组在术后6h、12h、24h的运动时NRS评分明显降低(P<0.05),高浓度组在术后2h、6h、12h、24h运动时NRS评分明显降低(P<0.05);与术前相比,术后各时间点的用力肺活量(FVC)均明显下降(P<0.05);与低浓度组相比,中浓度组和高浓度组在术后6h、12h、24h、48h的FVC值明显升高(P<0.05)。结论:超声引导下行单点胸椎旁神经阻滞时,给予0.5%罗哌卡因可完善围术期镇痛,延长术后镇痛时间,降低阿片类药物用量及副作用,改善肺功能,且安全性高。

Objective To investigate the analgesic effect and safety of the injection of different concentration of ropivacaine inthoracoscopic lobectomy for thoracoscopic surgery. Methods： 60 patients with thoracic lobectomy were randomly divided into 3 groups and 20cases in each group. Low -dose group： paravertebral block with 0.375% ropivacaine; middle -dose group： paravertebral block with 0.5%ropivacaine; high-dose group： paravertebral block with 0.75% ropivacaine. All patients were given to PCIA after operative. Observe the recovery,NRS scores at rest time and during cough after postoperative, analgesic adverse reaction, recording remifentanil dosage and the total number ofcompressions PCIA after operative; Record changes in blood pressure and heart rate during surgery; Determine lung function. Results： Thefrequency of PCIA in the low-dose group was significantly higher than that in the middle-dose group and high-dose group （P〈0.05）; the heart rateand blood pressure in the high-dose group were significantly lower than those in the preoperation and 30min after operation （P〈0.05）; Comparedwith the low-dose group, the NRS scores of the middle-dose and high-dose groups at rest were significantly lower at 6h （P〈0.05）, and the NRSscores at the time of coughing in the middle-dose group were significantly lower at 6h, 12h, and 24h （P〈0.05） . In the high-dose group, the NRSscores were significantly lower at 2h, 6h, 12h, and 24h compare with low-dose group（P〈0.05） . Compared with preoperation, the forced vitalcapacity （FVC）at every time point was significantly decreased （P〈0.05）; compared with the low-dose group, the FVC was significantly increasedin the medium-dose and high-dose groups at 6h, 12h, 24h, 48h （P〈0.05） . Conclusion： When ultrasound-guided single point thoracic paravertebralnerve block, given 0.5% ropivacaine can improve perioperative analgesia, prolong postoperative analgesic time, reduce opioid consumption andside effects, improve lung function, and more secure, so as to achieve the purpose of accelerating post-operative rehabilitation of this type ofsurgery.