右美托咪定复合罗哌卡因竖脊肌平面阻滞对胸腔镜手术疼痛控制的效果评价

Effect of dexmedetomidine combined with ropivacaine used in erector spinae plane block on postoperative pain after thoracoscopic surgery

目的探讨超声引导右美托咪定复合罗哌卡因竖脊肌平面阻滞对胸腔镜手术患者疼痛的控制效果。方法选取我院2017年6月至2018年9月择期胸腔镜手术的90例患者为研究对象,按照数字表法随机分为右美托咪定组(D组)、罗哌卡因组(R组)和对照组(C组),每组30例。三组均在术前行超声引导T5横突竖脊肌平面(Erector spinae plane,ESP)阻滞,D组给予1μg/kg右美托咪定复合0.4%罗哌卡因共25ml,R组给予0.4%罗哌卡因25ml,C组给予等量生理盐水,三组术后均连接静脉镇痛泵。记录三组患者术中血液动力学指标变化,术后静息时、咳嗽时VAS评分,记录三组患者镇痛药用量、镇痛泵有效按压次数与实际按压次数比(D1/D2)及不良反应。结果与C组相比,D组和R组胸腔镜置入前后血流动力学变化更为平稳;三组术后2、6、12、24、36、48h静息VAS评分和咳嗽VAS评分变化差异有统计学意义(P<0.05),D组变化更平稳,镇痛效果较好;与R组和C组比较,D组患者术后48h舒芬太尼用量显著减少(P<0.05),D1/D2显著增高(P<0.05)。D组术后恶心发生率低于R组、C组,术后呕吐发生率显著低于C组,差异均有统计学意义(P<0.05)。结论胸腔镜手术术前超声引导右美托咪定复合罗哌卡因ESP阻滞,术中血流动力学更平稳,术后患者疼痛控制的效果更好,并发症更少,值得临床推广。

Objective To investigate the effect of dexmedetomidine combined with ropivacaine used in ultrasound-guided erector spinae plane ( ESP) block on pain control in patients undergoing video-assisted thoracoscopic surgery. Methods Totally 90 cases receiving thoracoscopic surgery from June 2017 to September 2018 were randomly divided into dexmedetomidine group ( group D),ropivacaine group ( group R) and control group ( group C),30 cases in each group. All patients received ultrasound-guided ESP block on T5 transverse process before operation. Patients in group D was given 25 ml of 1 μg /kg dexmedetomidine mixed with 0. 4% ropivacaine,and group R was given 25 ml of 0. 4% ropivacaine,while group C was given the same amount of saline. Three groups received patient-controlled intravenous analgesia ( PCIA) after operation. The changes of hemodynamic parameters, VAS score at rest and cough, the dosage of analgesics,number of PCIA delivered ( D1 ) to demand( D2 ) D1 /D2 and adverse reactions were recorded. Results The hemodynamic parameters in group D and group R were more stable than those in group C during the thoracoscopic implantation;there was statistical difference in the rest and cough VAS scores at 2,6,12,24,36,and 48 h after operation ( P < 0. 05);the change of group D was more stable and the analgesic effect was better. The dosage of sufentanil in group D was significantly less than in group R and group C within 48 hours after operation ( P < 0. 05). The value of D 1 /D2 was significantly higher in group D than that in group R and group C ( P < 0. 05), and the incidence rate of nausea in group D was lower than that in group R and group C ( P < 0. 05);the incidence rate of vomiting in group D was lower than that in group C ( P < 0. 05). Conclusion Dexmedetomidine combined with ropivacaine used in ultrasound-guided ESP block before thoracoscopic surgery has more stable intraoperative hemodynamics, better postoperative pain control and fewer complications,which is worthy of clinical application.