超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜下胸交感神经切断术的麻醉效果观察

Anesthetic effects of ultrasound-guided thoracic paravertebral block combined with dexmedetomidine for thoracoscopic thoracicsympathectomy

目的:观察超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜下胸交感神经切断术的麻醉效果。方法:选取2016年1月至2018年2月于我院行胸腔镜下胸交感神经切断术的82例患者作为本次研究对象,全部患者按照随机数表法随机分为实验组和对照组,每组41人,实验组患者在行胸椎旁阻滞前15 min静脉泵注右美托咪定0.5 μg·kg -1 (4μg·ml -1 ),并以0.3 μg·kg -1 ·h -1 的速率泵至术毕;对照组患者以同样方式泵注等量生理盐水。观察并记录患者入室(T0)、胸椎旁阻滞穿刺后(T1)、切皮(T2)、交感神经切断(T3)、手术结束(T4)时的心率、呼吸机心率、平均动脉压、血氧饱和度(Oxygensaturation,SpO2)。记录患者术后1周的不良反应发生率。结果:与对照组相比,实验组患者T1~T4时间点心率、平均动脉压和SpO2明显降低(P<0.05);T1~T3时呼吸机心率明显低于对照组(P<0.05)。两组不良反应的发生率无统计学意义(P>0.05)。结论:超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜下胸交感神经节切断术麻醉效果较好且安全性良好,值得临床推广应用。

Objective:To observe the anesthetic effects of ultrasound-guided thoracic paravertebral block combined with dexmedetomidine for thoracoscopic thoracicsympathectomy.Methods: Eighty-two patients underwent thoracoscopic thoracic sympathectomy in our hospital from January2016 to February2018 were enrolled.All patients were randomly divided into the experimental group and the control group according to random number table method with 41 patients in each group.The experimental group was intravenously injected with dexmedetomidine 0.5μg·kg -115 min before thoracic paravertebral block,and 0.3 μg·kg -1 ·h -1 pumped during the surgery.The control group was pumped with the same amount of normal saline in the same manner.The heart rate,ventilator heart rate,mean arterial pressure,blood flow after patient admission (T0),thoracic parastomal puncture (T1),cut (T2),sympathectomy (T3),end of surgery (T4) Oxygen saturation (SpO2) SpO2 were recorded and compared.The incidence of adverse reactions during one week after surgery was recorded.Results: Compared with the control group,the experimental group had significantly decreased snack rate,mean arterial pressure and SpO2 in the experimental group from T1 to T4 (P<0.05).The heart rate of the ventilator in the experimental group was significantly lower than that in the control group at T1~T3 (P<0.05).There was no significant differences in the incidence of adverse reactions between the two groups (P>0.05).Conclusion: Ultrasound-guided thoracic paravertebral block combined with dexmedetomidine for thoracic sympathectomy is safe,which is worthy of clinical application.