右美托咪定联合罗哌卡因B超引导下神经阻滞术对胸腔镜手术患者术后镇痛的疗效观察

Curative Effect of Type-B ultrasonic-guided Nerve Block by Dexmedetomidine Combined with Ropivacaine on Postoperative Analgesia in Patients Undergoing Thorascopic Surgery

目的探究胸腔镜手术患者使用右美托咪定联合罗哌卡因B超引导下神经阻滞术对术后镇痛的影响。方法回顾性分析我院2017年5月-2018年5月期间收治120例接受胸腔镜手术患者的临床资料,依据患者麻醉剂不同分为联合组68例和对照组52例。联合组采用右美托咪定和罗哌卡因;对照组采用罗哌卡因和生理盐水。比较2组患者术后不同时间静息状态和活动状态疼痛视觉模拟评分(VAS),不同时间点Ramsay评分和BCS评分,血清疼痛学指标水平,术后并发症发生率。结果联合组术后4、8、12 h静息状态和活动状态的VAS评分均显著低于对照组(P<0.05),联合组术后4、8、12 h的Ramsay评分和BCS评分均显著高于对照组(P<0.05)。2组患术后24、48 h时静息和活动VAS评分、Ramsay评分和BCS评分比较差异无统计学意义(P>0.05);联合组患者术后8、24和48 h时前列腺素E2、白介素-17、高迁移率簇蛋白等血清疼痛学指标水平低于对照组(P<0.05);联合组并发症发生率低于对照组(P<0.05)。结论胸腔镜手术中在B超引导下使用右美托咪定复合罗哌卡因进行神经阻滞镇痛镇静效果较好,术后并发症少。

Objective To investigate curative effect of type-B ultrasonic-guided nerve block by Dexmedetomidine combined with Ropivacaine on postoperative analgesia in patients undergoing thorascopic surgery.Methods Clinical data of 120 patients undergoing thorascopic surgery admitted during May 2017 and May 2018 was retrospectively analyzed,and the patients were divided into combined group(n=68)and control group(n=52)according to different anesthetics.Combined group was treated with Dextromethopyrimidine and Ropivacaine,while control group was treated with Ropivacaine and physiological saline.Resting and active visual analogue scales(VAS)scores,Ramsay score and BCS score at different time points,serum levels of pain indexes and incidence rate of postoperative complications were compared between two groups.Results At 4 h,8 h,and 12 h after operation in combination group,resting and active VAS scores were significantly lower(P<0.05),while Ramsay and BCS scores were significantly higher than those in control group(P<0.05).There were no significant differences in resting and active VAS scores,Ramsay and BCS scores at 24 h and 48 h after operation between two groups(P>0.05).At 8 h,24 h and 48 h after operation,levels of serum pain indexes such as prostaglandin e2(PGE2),interleukin-17(IL-17)and high mobility group box chromosomal protein B1(HMGB1)in combination group were significantly lower than those in control group(P<0.05).Incidence rate of complications in combination group was significantly lower than that in control group(P<0.05).Conclusion Analgesia effect of type-B ultrasonic-guided nerve block by Dexmedetomidine combined with Ropivacaine is better in application of thorascopic surgery with few postoperative complications.