罗哌卡因复合地塞米松胸椎旁神经阻滞对胸腔镜下肺叶切除术患者术后镇痛效果与恢复质量的影响

Effect of Ropivacaine Combined with Dexamethasone Thoracic Paravertebral Nerve Block on Postoperative Analgesia and Recovery Quality of Patients Un-dergoing Thoracoscopic Lobectomy

目的观察罗哌卡因复合地塞米松胸椎旁神经阻滞(thoracic paravertebralnerve block,TPVB)对胸腔镜下肺叶切除术患者术后镇痛效果与恢复质量的影响。方法选取笔者医院择期行胸腔镜下肺叶切除术的患者60例,随机分为对照组(R组)和试验组(RD组),每组30例,在麻醉诱导前行TPVB:R组注入0.5%罗哌卡因20ml+2mlNS;RD组注入0.5%罗哌卡因20ml+2ml地塞米松(10mg)。记录两组TPVB的起效时间、镇痛持续时间,记录术后各个时间点静息和运动(咳嗽时)视觉模拟评分(VAS)以及咳痰能力分级。记录术后1天和2天QoR-15量表评分以及术后当晚阿森斯失眠量表(Athens insomnia scale,AIS)评分,记录24h内按压镇痛泵的次数,记录不良反应的发生情况。结果与R组比较,RD组TPVB作用持续时间明显延长、起效时间明显缩短、24h内镇痛泵的按压次数明显减少(P<0.05);两组患者术后2、18、24h的静息和运动VAS以及咳痰能力相似(P>0.05),术后4h R组患者的静息和运动VAS均低于RD组(P<0.05),术后8h R组患者的静息VAS低于RD组(P<0.05),而运动VAS差异无统计学意义(P>0.05)。术后4、8h RD组患者咳痰能力高于R组(P<0.05)。RD组术后1天和术后2天QoR-15评分均低于R组(P<0.05);与R组比较,RD组虽然术后当晚AIS评分提示存在可疑失眠,但其评分仍低于R组(P<0.05)。两组患者术后恶心、呕吐、皮肤瘙痒等不良反应发生率比较,差异无统计学意义(P>0.05)。结论罗哌卡因复合地塞米松胸椎旁神经阻滞可为胸腔镜下肺叶切除术患者提供有效的术后镇痛,可延长镇痛持续时间、缩短起效时间,并可改善患者术后咳痰能力以及睡眠质量,加速患者恢复。

Objective To observe the effect of ropivacaine combined with dexa-methasone thoracic paravertebral nerve block(TPVB)on postoperative analgesia and recovery quality of patients undergoing thoracoscopic lobectomy.Methods Sixty patients who underwent thoracoscopic lobectomy in our hospital were randomly divided into two groups:control group(group R)and experimental group(group RD).Each group had 30 patients.Thoracic paravertebral nerve block was induced before anesthesia:Group R was injected with 0.5%ropivacaine 20ml+2ml normal saline(NS);Group RD was injected with 0.5%ropivacaine 20ml+2ml dexamethasone(10mg).The onset time and duration of analgesia of TPVB were recorded,and the rest and movement(cough time)visual analogue score(VAS)and the grade of expectoration ability were recorded.The Qor-15 scoresof the quality of recovery scale on the first day and the second day after the operation were recorded,and the scores of the arthens Insomnia Scale on the night after the operation were recorded,and record the times of pressing the analgesia pump within 24 hours,and the occurrence of adverse reactions such as nausea and vomiting,pruritus and so on were recorded.Results Compared with group R,the duration of TPVB action in the group RD was significantly longer and the onset time was significantly shorter,and the number of pressionof analgesia pump decreased significantly within 24 hours(P<0.05);the scores of resting and exercise VAS and the expectoration ability in the two groups were similar at 2,18,24hours after operation(P>0.05),and the scores of resting and exercise VAS in the group R were lower than those in the group RD at 4hours after operation(P<0.05).The rest VAS score of group R was lower than that of group RD(P<0.05),but there was no significant difference in exercise VAS score(P>0.05).The expectoration ability of group RD was higher in the 4 and 8 hours than group R(P<0.05).Qor-15 score of group RD was lower than that of group R(P<0.05).Compared with Group R,the sleep quality score of Group RD was lower than that of Group R(P<0.05).There was no significant difference in the incidence of adverse reactions(P>0.05).Conclusion Ropivacaine combined with dexamethasone TPVB can provide effective postoperative analgesia for patients undergoing thoracoscopic lobectomy,prolong the duration of analgesia,shorten the onset time,improve the ability of expectoration and sleep quality,and accelerate the recovery of patients.