超声引导下右美托咪定复合罗哌卡因椎旁神经阻滞对开胸手术患者肺功能的保护作用

Protective effect of ultrasound-guided paravertebral block with dexmedetomidine and ropivacaine on lung function during thoracotomy

目的了解超声引导下右美托咪定复合罗哌卡因椎旁神经阻滞对开胸手术患者肺功能的保护作用。方法160例开胸手术患者分别采用全麻下开胸手术(对照组)或加用超声引导下右美托咪定复合罗哌卡因椎旁神经阻滞(观察组)。比较两组麻醉前(T1)、通气后1 h(T2)和2 h(T3)、术后2 h(T4)血气水平,血清TNF-α、IL-6、MIP-1水平,以及肺功能异常发生情况。结果与对照组比较,观察组术后肺功能异常及T4血清TNF-α、IL-6、MIP-1水平较低,T3、T4时PaO_(2)、OI、SpO_(2)较高(P<0.01或0.05)。结论超声引导下右美托咪定复合罗哌卡因椎旁神经阻滞可提高开胸手术患者的氧合情况,降低血清炎症因子水平,从而保护肺功能。

Objective To study the protective effect of ultrasound-guided paravertebral block(TVB)with dexmedetomidine and ropivacaine on lung function during thoracotomy.Methods A total of 160 patients undergoing thoracotomy were randomly treated with general anesthesia(control group)or additional ultrasound-guided TVB with dexmedetomidine and ropivacaine(observation group).Arterial blood gas before anesthesia(T1),1 h(T2)and 2 h(T3)postventilation,and 2 h(T4)postoperation;serum levels of TNF-α,IL-6,and MIP-1;and pulmonary dysfunction were compared between two groups.Results Compared with control group,postoperative abnormality of lung function and serum levels of TNF-α,IL-6,and MIP-1 at T4 were lower,while PaO_(2),OI and SpO_(2) at T3 and T4 were higher in observation group(P<0.01 or 0.05).Conclusion Ultrasound-guided TVB with dexmedetomidine and ropivacaine can improve oxygenation and serum inflammatory factor levels during thoracotomy,leading to a protective role in lung function.