开胸手术患者给予右美托咪定联合罗哌卡因对应激指标、术后镇痛的影响

Effect of Dexmedetomidine Combined with Ropivacaine on Stress Indicators and Postoperative Analgesia in Patients Under Going Thoracotomy

目的探讨开胸手术患者给予右美托咪定(Dex)联合罗哌卡因对患者应激反应指标、术后镇痛的影响。方法选取我院拟实施开胸手术患者140例,采用数字表分为研究组和对照组各70例,对照组麻醉诱导前椎旁阻滞给药及术后镇痛均给予罗哌卡因,研究组麻醉诱导前椎旁阻滞给药及术后镇痛均给予罗哌卡因+Dex;对比两组患者的血流动力学指标、血浆肾上腺素(E)、去甲肾上腺素(NE)、疼痛程度评分、自控镇痛(PCA)按压次数、地佐辛用量、不良反应情况。结果研究组在T1、T2、T3时刻的MAP、HR值高于对照组(P<0.05),研究组在T4时刻的MAP、HR值低于对照组(P<0.05),研究组和对照组的BIS值在T0~T4时刻差异均无统计学意义(P>0.05);术前两组患者血浆E、NE水平差异无统计学意义(P>0.05);术后12、24 h,研究组血浆E、NE水平均低于对照组(P<0.05);观察两组患者的VAS评分,研究组在术后4、12 h均低于对照组,差异有统计学意义(P<0.05);研究组PCA按压次数、地佐辛用量均低于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率(8.57%)与对照组(4.29%)比较,差异无统计学意义(P>0.05)。结论开胸手术患者麻醉诱导前、术后镇痛给予Dex联合罗哌卡因有利于减轻手术引起的应激反应、维持术中血流动力学稳定、减轻术后疼痛程度。

Objective To explore the effect of dexmedetomidine(Dex)combined with ropivacaine on patients’stress response and postoperative analgesia.Methods 140 patients who undergo thoracotomy in our hospital were selected,and they were divided into study group(n=70)and control group(n=70)by using digital table.Control group was given ropivacaine before anesthesia induction and analgesia after operation.Instudy group,ropivacaine+Dex was given to paravertebral block before anesthesia induction and postoperative analgesia.Hemodynamic indicators,plasmaepinephrine(E),norepinephrine(NE),pain degree score,PCA compressions,dezocine dosageand adverse reactions were compared.Results MAP and HR of study group at T1,T2,and T3 were higher than those of control group(P<0.05).MAP and HR of study group at T4 were lower than those of control group(P<0.05).There was no statistically significant difference in BIS from T0 to T4(P>0.05).There was no significant difference in plasma E and NE before operation(P>0.05).After 12 hours and 24 hours,plasma E and NE of study group were lower than those of control group(P<0.05).By observing VAS scores,study group was lower than control group at 4 h and 12 h after surgery with statistically significant difference(P<0.05).The number of PCA compressions and amount of dezocine in study group were lower than those in control group with statistically significant difference(P<0.05).There was no statistically significant difference in incidence of adverse reactions between study group(8.57%)and control group(4.29%)(P>0.05).Conclusion Dex combined with ropivacaine for analgesia before and after anesthesia induction for patients undergoing thoracotomy could reduce stress response caused by surgery,maintain intraoperative hemodynamics stability and reduce postoperative pain.