不同剂量右美托咪定复合罗哌卡因对全麻胸腔镜术后患者镇痛及早期恢复的影响

Effect of different doses of dexmedetomidine combined with ropivacaine on postoperative analgesia and early recovery in patients undergoing a thoracoscopic surgery under general anesthesia

目的探讨不同剂量右美托咪定复合罗哌卡因对全麻胸腔镜术后患者镇痛及早期恢复的影响。方法选择行全麻胸腔镜手术治疗患者136例为研究对象,以随机数表法分为低剂量组(0.50μg·kg^(-1))、中剂量组(1.00μg·kg^(-1))、高剂量组(2.00μg·kg^(-1))及对照组(等量生理盐水),各34例。对比4组手术时间、术中出血量、视觉疼痛模拟(VAS)评分、术后早期恢复质量及术后不良反应。结果4组手术时间、术中出血量对比差异不显著(P>0.05)。中剂量组和高剂量组术后2 h VAS评分均低于对照组和低剂量组(P<0.05),中剂量组术后2 h VAS评分低于高剂量组(P<0.05);术后6 h、4组术后12 h及24 h组间VAS评分对比,差异不显著(P>0.05)。中剂量组和高剂量组术后3 d QoR-40评分高于对照组和低剂量组(P<0.05),中剂量组术后3 d QoR-40评分高于高剂量组(P<0.05)。4组术后不良反应总发生率差异不明显(P>0.05)。结论采用右美托咪定复合罗哌卡因对全麻胸腔镜手术患者的麻醉效果较好,且剂量为1.00μg·kg^(-1)右美托咪定复合罗哌卡因在术后镇痛、早期恢复质量方面效果最好。

Objective To investigate the effect of different doses of dexmedetomidine combined with ropivacaine on the postoperative analgesia and early recovery in patients undergoing a thoracoscopic surgery under general anesthesia.Methods A total of 136 patients who underwent a thoracoscopic surgery under general anesthesia were selected as the research subjects,and were randomly divided into a low-dose group(0.50μg·kg^(-1)),a medium-dose group(1.00μg·kg^(-1)),a high-dose group(2.00μg·kg^(-1))and a control group(the same amount of normal saline),with 34 cases in each group.The operation time,intraoperative bleeding,Visual Analogue Scale(VAS)of pain,early postoperative recovery quality and postoperative adverse reactions were compared between the 4 groups.Results There was no significant difference in operation time and intraoperative bleeding among the 4 groups(P>0.05).The VAS scores of the middle-dose group and the high-dose group at 2 hours after operation were both lower than those of the control group and the low-dose group(P<0.05),and the medium-dose group was lower than the high-dose group(P<0.05).There was no significant difference in the VAS scores between the groups at 6 h,12 h and 24 h after operation(P>0.05).The 40-item Quality of Recovery Scale(QoR-40)scores in the middle-dose group and high-dose group after operation were higher than those in the control group and low-dose group(P<0.05),and the QoR-40 score in the middle-dose group on the 3rd day after operation was higher than that in the high-dose group(P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions among the 4 groups(P>0.05).Conclusion Dexmedetomidine combined with ropivacaine has a better anesthesia effect in patients undergoing a thoracoscopic surgery under general anesthesia,and the dose of 1.00μg·kg^(-1) dexmedetomidine combined with ropivaca has the best effect in the postoperative analgesia and early recovery quality.