罗哌卡因复合地佐辛胸椎旁神经阻滞对开胸手术应激反应的影响

Effect of Ropivacaine combined with dezocine thoracic paravertebral nerve block on stress response during thoracotomy

目的观察罗哌卡因复合地佐辛在胸椎旁神经阻滞开胸手术中对应激反应的影响。方法选取2017年6月—2018年5月哈励逊国际和平医院麻醉科择期行开胸手术肺叶切除患者60例,随机数字表法将患者均分为对照组(C组)、罗哌卡因组(R组)、罗哌卡因复合地佐辛组(D组),各20例。3组均行全凭静脉麻醉,C组不行椎旁神经阻滞;R组采用罗哌卡因胸椎旁神经阻滞;D组采用罗哌卡因复合地佐辛胸椎旁神经阻滞。检测3组患者麻醉前(T0)、术毕即刻(T1)、术后6 h(T2)血浆肾上腺素(E)、去甲肾上腺素(NE)、皮质醇浓度及血清白介素-6(IL-6)、IL-10及肿瘤坏死因子α(TNF-α)浓度;记录3组患者术后30 min及术后60 min时VAS评分、术后48 h内使用PCIA次数及不良反应发生例数。结果3组患者T1、T2时点血浆E、NE及皮质醇浓度,较T0时点升高(C组:F/P=576.824/0.000,1075.002/0.000,91.299/0.000;R组:F/P=144.243/0.000,324.071/0.000,45.779/0.000;D组:F/P=178.720/0.000,321.495/0.000,71.362/0.000);与C组比较,D组、R组T1、T2时点血浆E、NE及皮质醇浓度降低(P<0.05)。3组患者T1、T2时点血清IL-6、IL-10及TNF-α浓度,较T0时点升高(C组:F/P=4042.066/0.000,6845.810/0.000,512.986/0.000;R组:F/P=1375.622/0.000,7743.938/0.000,286.990/0.000;D组:F/P=1720.260/0.000,3165.305/0.000,226.081/0.000);与C组比较,D组、R组T1、T2时点血清IL-6、TNF-α浓度降低(P<0.05),IL-10浓度升高(P<0.05)。术后30 min、术后60 min VAS评分比较,D组<R组<C组(P<0.05)。术后48 h内镇痛泵按压次数比较,D组<R组<C组(P<0.05)。D组与R组术后48 h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佐辛胸椎旁神经阻滞能在一定程度减轻开胸手术后的应激反应,术后镇痛效果较好,且不增加术后不良反应发生率。

Objective To observe the effect of Ropivacaine combined with dezocine on the stress response during thoracic paravertebral nerve block thoracotomy.Methods From June 2017 to May 2018,60 patients with elective thoracotomy for lobectomy were selected from the Department of Anesthesiology,Harrison International Peace Hospital,and the patients were divided into control group(group C)and Ropivacaine group by random number table method.(R group),Ropivacaine combined with dezocine group(D group),20 cases each.All 3 groups underwent intravenous anesthesia,and no paravertebral nerve block in group C.The R group received thoracic paravertebral nerve block with Dezocine.In group D,thoracic paravertebral nerve block was performed with Ropivacaine combined with dezocine.Detect plasma epinephrine(E),norepinephrine(NE),cortisol concentration and serum interleukin 6(IL-6)before anesthesia(T0),immediately after surgery(T1),and 6 hours after surgery(T2)in 3 groups of patients,IL-10 and tumor necrosis factor-α(TNF-α)concentration.The VAS scores at 30 min and 60 min after surgery,the number of PCIA used within 48 hours after surgery,and the number of adverse reactions in the 3 groups were recorded.Results The plasma E,NE and cortisol concentrations at T1 and T2 in the three groups were higher than those at T0(group C:F/P=576.824/0.000,1075.002/0.000,91.299/0.000;group R:F/P=144.243/0.000,324.071/0.000,45.779/0.000;Group D:F/P=178.720/0.000,321.495/0.000,71.362/0.000).Compared with group C,plasma E,NE and cortisol concentrations at T1 and T2 in group D and R decreased(P<0.05).Serum IL-6,IL-10 and TNF-αconcentrations at T1 and T2 in the three groups were higher than those at T0(group C:F/P=4042.066/0.000,6845.810/0.000,512.986/0.000;group R:F/P=1375.622/0.000,7743.938/0.000,286.990/0.000;Group D:F/P=1720.260/0.000,3165.305/0.000,226.081/0.000).Compared with group C,serum IL-6 and TNF-αconcentrations at T1 and T2 in group D and R decreased(P<0.05),and the concentration of IL-10 increased(P<0.05).Comparison of VAS scores at 30 min and 60 min after surgery,group D<group R<group C(P<0.05).Comparison of the number of analgesic pump compressions within 48 hours after operation,group D<group R<group C(P<0.05).There was no significant difference in the incidence of adverse reactions between group D and group R at 48 h after surgery(P>0.05).Conclusion Ropivacaine combined with dezocine thoracic paravertebral nerve block can reduce the stress response after thoracotomy to a certain extent,and the postoperative analgesia effect is better without increasing the incidence of postoperative adverse reactions.