椎旁神经阻滞复合右美托咪定对开胸手术围术期应激反应的影响

Effects of Paravertebral Blocks Combined with Dexmedetomidine on Perioperative Stress Response In Thoracotomy

目的:探讨椎旁神经阻滞复合右美托咪定对开胸手术围术期应激反应的影响。方法:选取2016年5月至2017年6月潜江市中心医院收治的拟行开胸手术患者86例作为研究对象,以随机数字表法分为A、B组,每组43例。A组患者进行椎旁神经阻滞后实施全身麻醉,B组患者进行椎旁神经阻滞复合右美托咪定后实施全身麻醉。观察两组患者不同时间点[麻醉诱导前(T_0)、气管插管即刻(T_1)、手术2 h(T_2)、术毕(T_3)、术后1 h(T_4)、术后8 h(T_5)及术后24 h(T_6)]心率(HR)、平均动脉血压(MAP)水平及术后镇静镇痛情况。结果:T_2、T_3时,A组患者HR水平明显高于B组,差异有统计学意义(P<0.05);T_3、T_4时,A组患者MAP水平明显高于B组,差异有统计学意义(P<0.05)。T_4—T_6时,B组患者疼痛视觉模拟评分明显低于A组,差异均有统计学意义(P<0.05);两组患者Ramsay镇静评分的差异均无统计学意义(P>0.05)。结论:椎旁神经阻滞复合右美托咪定可抑制开胸手术围术期应激反应。

OBJECTIVE:To probe into the effects of effects of paravertebral blocks combined with dexmedetomidine on perioperative stress response in thoracotomy.METHODS:86patients undergoing thoracotomy admitted into Qianjiang Central Hospital from May2016to Jun.2017were selected and divided into group A and group B via random number table,with43cases in each.Group A was given paravertebral blocks for general anesthesia,while group B was given paravertebral blocks combined with dexmedetomidine.The heart rates(HR),mean arterial pressure(MAP)and postoperative analgesia of both groups at different time periods[before the induction of anesthesia(T0),Immediate intubation(T1),2hours after the start of operation(T2),after operation(T3),1hour after operation(T4),8hours after operation(T5),and24hours after operation(T6)]were observed.RESULTS:At T2and T3,the HR level of group A was significantly higher than that of group B,with statistically significant difference(P<0.05);at T3and T4,the MAP level of group A was significantly higher than that of group B,with statistically significant difference(P<0.05).At T4-T6,the VAS scores of group B was significantly lower than that of group A,with statistically significant difference(P<0.05);while there was no statistical significance in difference of Ramsay sedation scores between two groups(P>0.05).CONCLUSIONS:The combination of paravertebral blocks combined with dexmedetomidine can inhibit the perioperative stress response in thoracotomy.