右美托咪定复合罗哌卡因行胸椎旁神经阻滞在冠脉搭桥术中的应用及对术后镇痛的影响

Application of thoracic paravertebral nerve block with dexmedetomidine and ropivacaine in coronary artery bypass grafting and its effect on postoperative analgesia

目的分析右美托咪定复合罗哌卡因行胸椎旁神经阻滞(TPVB)在冠状动脉(冠脉)搭桥手术患者中的应用及对术后镇痛的影响。方法回顾性分析2016年12月至2019年5月在华北理工大学附属医院行不停跳冠脉搭桥术192例患者的临床资料,将全麻诱导前给予0.35%罗哌卡因30 ml行TPVB的94例列为对照组,给予右美托咪定注射液1μg/kg+0.35%罗哌卡因30 ml行TPVB的98例列为研究组。比较两组以下指标:ICU滞留时间、拔管时间、住院时间;入室安静状态下(t_(0))、胸椎旁给药15 min(t_(1))、气管插管即刻(t_(2))、切皮后5 min(t_(3))、术毕拔管前(t_(4))时的平均动脉压(MAP)、心率(HR);术后6、12、24、48 h时的疼痛视觉模拟评分(VAS);循环稳定性、并发症及不良反应。结果研究组ICU滞留时间、拔管时间、住院时间显著低于对照组(P<0.01);在t_(1)-t_(4)时MAP、HR明显低于对照组(P<0.01);在术后24、48 h时VAS评分明显低于对照组(P<0.01);术后24 h窦性心动过缓发生率、低血压发生率两组相近(P>0.05),研究组患者高血压、窦性心动过速发生率明显低于对照组(P<0.05,P<0.01);术后24 h两组患者均未出现呼吸抑制、寒战、肺部感染、肺不张;研究组和对照组恶心呕吐(3.06%vs 4.26%,P>0.05)、感觉异常发生率(2.04%vs 3.19%,P>0.05)比较差异均无统计学意义。结论右美托咪定复合罗哌卡因行TPVB在不停跳冠脉搭桥术中应用,有助于维持机体血流动力学稳定,减少高血压及心动过速的发生,且并发症及不良反应少,术后镇痛效果好。

Objective To analyze the application of thoracic paravertebral nerve block with dexmedetomidine and ropivacaine in coronary artery bypass grafting(CABG)and its effect on postoperative analgesia.Methods A retrospective analysis was performed on the clinical data of 192 patients received off-pump CABG from December 2016 to May 2019.Ninty-four patients who were given 30 ml of 0.35%ropivacaine for TPVB before general anesthesia induction were selected as control group,and 98 patients who were given 1 μg/kg dexmedetomidine injection combined with 30 ml of 0.35%ropivacaine for TPVB were selected as study group.The intensive care unit(ICU)retention time,extubation time and hospitalization time were compared between two groups.Mean arterial pressure(MAP)and heart rate(HR)were measured at 5 time points[in a quiet state before injection(t_(0)),15-min after thoracic paravertebral administration(t_(1)),at tracheal intubation immediately(t_(2)),5-min after skin incision(t_(3))and before extubation after operation(t_(4))].At postoperative 6-,12-,24-and 48-h,visual analogue score(VAS),circulatory stability,complications and adverse reactions were observed and compared between two groups.Results ICU detention time,extubation time,hospital stay and MAP and HR at t_(1)-t_(4) in study group were significantly shorter than those in control group(P<0.01),and VAS scores at postoperative 24-and 48-h were significantly lower than those in control group(P<0.01).The incidences of hypotension and sinus bradycardia were similar in two groups(P>0.05),and the incidence of hypertension and sinus tachycardia in study group was significantly lower than those in control group(P<0.05).At 24 hours after surgery,no respiratory depression,chills,pulmonary infection and atelectasis occurred in both groups.There was no significant differences in incidences of nausea and vomiting(3.06%vs 4.26%)and paresthesia(2.04%vs 3.19%)between two groups(P>0.05).Conclusion The application of TPVB with dexmedetomidine and ropivacaine for off-pump CABG is helpful to maintain hemodynamic stability,reduce the incidence of hypertension and tachycardia,with fewer complications and adverse reactions,and has better postoperatine analgesic effect.