不同剂量右美托咪定复合罗哌卡因胸椎旁神经阻滞在非插管胸腔镜手术中的比较

Comparison of thoracic paravertebral block with different doses of dexmedetomidine and ropivacaine in non-intubation thoracoscopic surgery

目的比较不同剂量右美托咪定复合罗哌卡因胸椎旁神经阻滞在非插管胸腔镜手术中的效果。方法择期行胸腔镜肺大泡切除术的患者114例,男90例,女24例,年龄25～60岁,BMI<25 kg/m^2,ASAⅠ或Ⅱ级,随机分为四组。麻醉诱导前行胸椎旁神经阻滞,C组注入0.375%罗哌卡因20 ml, D1、D2、D3组分别注入右美托咪定0.5、1.0、2.0μg/kg复合0.375%罗哌卡因20 ml。记录感觉阻滞起效时间和持续时间;入室时(T_0)、注药后30 min(T_1)、手术开始时(T_2)、手术开始后30 min(T_3)的RR、PaO_2和PaCO_2;术毕全麻药的用量;术中低血压、心动过缓和使用麻黄碱与阿托品的情况。结果与C、D1组比较,D2、D3组感觉阻滞起效时间明显缩短(P<0.05),持续时间明显延长(P<0.05),T_2、T_3时PaCO_2明显降低(P<0.05),RR、PaO_2明显升高(P<0.05),术毕丙泊酚和瑞芬太尼的用量明显减少(P<0.05);D3组心动过缓和低血压的发生率明显高于其他三组(P<0.05)。结论右美托咪定1.0μg/kg复合罗哌卡因行胸椎旁神经阻滞可缩短感觉阻滞起效时间,延长持续时间,减少全麻药用量,无明显血流动力学不良反应发生。

Objective To observe the efficacies of thoracic paravertebral block with different doses of dexmedetomidine and ropivacaine in non-intubation thoracoscopic surgery.Methods A total of 114 patients undergoing selective day thoracoscopic alveolectomy were randomly individed into four groups with 30 patients in each group.In groups D1,D2,D3,0.375%ropivacaine 20 ml with 0.5μg/kg,1.0μg/kg,2.0μg/kg dexmedetomidine were separately administrated to perform thoracic paravertebral nerve block,0.375%ropivacaine 20 ml were administrated to group C.RR,PaO2 and PaCO2 were recorded at the moment of in operating room(T0),30 minutes after thoracic paravertebral block(T1),beginning of operation(T2),30 min after operation begining(T3).The dosage of propofol and remifentanil、incidence of hypotension and bradycardia,sensory block onset time and blockade durations were also recorded.Results Compared with groups C and D1,sensory block onset time was shorter and blockade duration was longer(P<0.05),PaCO2 decreased and RR,PaO2 were higher at T2 and T3(P<0.05),the dosage of propofol and remifentanil decreased(P<0.05)in groups D2 and D3.The incidence of hypotension and bradycardia was higher in group D3 than in other groups(P<0.05).Conclusion dexmedetomidine 1.0μg/kg in combination with ropivacaine for thoracic paravertebral block can shorten sensory block onset time and prolong the duration of sensory blockade,reduce the amount of anesthetics,maintain hemodynamic stability.