罗哌卡因复合右美托咪定竖脊肌平面阻滞在胸椎手术中的应用

Application of Ropivacaine combined with Dexmedetomidine erector spinal block in thoracic spine surgery

目的探讨在胸椎手术中应用罗哌卡因复合右美托咪定竖脊肌平面阻滞的临床效果。方法选取2019年6月至2020年11月于赣州市人民医院拟接受胸椎手术治疗的60例患者作为研究对象,采用随机数字表法分为实验组和对照组,每组各30例。对照组行胸椎手术时采用罗哌卡因竖脊肌平面阻滞,实验组采用罗哌卡因复合右美托咪定竖脊肌平面阻滞,比较两组患者术中心率及平均动脉压、全麻药物用量、麻醉后恢复室(PACU)苏醒时间、苏醒期并发症,比较术后2、4、8、12 h的视觉模拟评分法(VAS)评分,术后患者静脉镇痛按压次数和满意度。结果实验组的术中心率、平均动脉压低于对照组,全麻药物用量少于对照组,PACU苏醒时间短于对照组,差异有统计学意义(P<0.05);两组术后4、8、12 h的VAS评分均高于本组术后2 h,且实验组不同时间点的VAS评分均低于对照组,差异有统计学意义(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞可用于胸椎手术镇痛,右美托咪定能明显延长罗哌卡因的作用时间,提供更完善的镇痛效果,有利于胸椎手术患者术后快速康复。

Objective To study the clinical effect of Ropivacaine combined with Dexmedetomidine erector spinal block in thoracic spine surgery.Methods A total of 60 patients who planned to receive thoracic surgery in Ganzhou People′s Hospital from June 2019 to November 2020 were selected as the research objects.They were divided into experimental group and control group by random number table method,with 30 patients in each group.The control group was given Ropivacaine erector plane block during thoracic surgery,and the experimental group was given Ropivacaine combined with Dexmedetomidine erector plane block.The operation center rate,mean arterial pressure,dosage of general anesthetics,recovery time of post-anesthesia recovery room(PACU)and complications in recovery period were compared between the two groups.The visual analogue scale(VAS)score at 2,4,8 and 12 h after operation,the number of intravenous analgesic compressions and the satisfaction of patients were compared.Results The operation center rate and mean arterial pressure in the experimental group were lower than those in the control group,the dosage of general anesthesia was lower than that in the control group,and the time of PACU recovery was shorter than that in the control group,the differences were statistically significant(P<0.05).VAS scores of both groups at 4,8 and 12 h after operation were higher than those of this group at 2 h after block,and VAS scores of the experimental group at different time points were lower than those of the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Ultrasonic-guided ropivacaine combined with dexmedetomidine erector spinal muscle plane block can be used for thoracic spine surgery analgesia.Dexmedetomidine can significantly prolong the action time of ropivacaine,provide a more complete analgesic effect,and is conducive to the rapid postoperative recovery of patients undergoing thoracic surgery.