超声引导胸椎旁神经阻滞联合右美托咪定用于开胸手术的麻醉及镇痛效果

Analgesic and Sedative Effects of Ultrasound-guided Thoracic Paravertebral Nerve Block Combined with Dexmedetomidine in Thoracotomy

目的探讨超声引导胸椎旁神经阻滞(TPVB)联合右美托咪定用于开胸手术的麻醉及镇痛效果。方法选取2019年1月1日—2022年10月31日120例行开胸手术的肺癌患者为研究对象,根据麻醉方案不同分为对照组和观察组,每组60例。对照组采取硬膜外阻滞复合全麻,观察组采取TPVB联合右美托咪定复合全麻。观察2组手术相关指标、炎症指标、应激指标、术后镇痛和镇静情况、术后恢复质量及不良反应发生情况。结果观察组术后24 h地佐辛用量少于对照组,补救镇痛比例低于对照组,住院时间短于对照组(P<0.01)。手术开始2 h、术毕、术后24 h,观察组血清白细胞介素-6、C反应蛋白、肿瘤坏死因子-α、超氧化物歧化酶、皮质醇、促肾上腺皮质激素水平均低于对照组(P<0.05)。术后6、12、24 h,观察组疼痛视觉模拟量表评分(静息和咳嗽时)、Ramsay镇静量表评分均低于对照组(P<0.01)。观察组术后6 h的40项恢复质量评分量表各维度评分均高于对照组,术后72 h除疼痛外其他各维度评分均高于对照组(P<0.01)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论超声引导TPVB联合右美托咪定用于开胸手术时,能降低炎性因子水平,减轻机体应激反应,提高术后镇痛、镇静效果,且不增加不良反应。

Objective To investigate the analgesic and sedative effects of ultrasound-guided thoracic paravertebral nerve block(TPVB)combined with Dexmedetomidine in thoracotomy.Methods A total of 120 patients with lung cancer who underwent thoracotomy from January 1,2019 to October 31,2022 were selected as the research subjects and divided into control group(n=60)and observation group(n=60)according to different anesthesia programs.The control group received epidural block combined with general anesthesia,and the observation group received TPVB and Dexmedetomidine combined with general anesthesia.Operation-related indexes,inflammatory indexes,stress indexes,postoperative analgesia and sedation,postoperative recovery quality and the occurrence of adverse reactions were observed in the two groups.Results The dosage of Desocine at 24 h after operation in the observation group was lower than that in the control group,the proportion of relief analgesia was lower than that in the control group,and the length of hospitalization was shorter than that in the control group(P<0.01).Serum levels of interleukin-6,C-reactive protein,tumor necrosis factor-α,superoxide dismutase,cortisol and adrenocorticotropin in the observation group were lower than those in the control group at 2 h after initiation of operation,immediately after operation,and at 24 h after operation(P<0.05).At 6,12 and 24 h after operation,the scores of visual Analog Scale(at rest and coughing)and Ramsay Sedation Scale in the observation group were lower than those in the control group(P<0.01).At 6 h after operation,the scores of 40 items of recovery quality scale in the observation group were higher than those in the control group(P<0.01).At 72 h after operation,the scores of all dimensions except pain in the observation group were higher than those in the control group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided TPVB combined with Dexmedetomidine used in thoracotomy can reduce the level of inflammatory factors,reduce the stress response of the body,improve postoperative analgesic and sedative effect,and do not increase adverse reactions.