罗哌卡因复合亚甲蓝椎旁阻滞对胸腔镜肺段切除手术患者血流动力学及术后镇痛的影响

Effects of Ropivacaine Combined with Methylene Blue Paravertebral Block on Hemodynamics and Postoperative Analgesia in Patients Undergoing Thoracoscopic Segmentectomy

目的研究罗哌卡因复合亚甲蓝椎旁阻滞对胸腔镜肺段切除手术患者血流动力学及术后镇痛的影响。方法选取2020年5月-2022年5月在我院行胸腔镜肺段切除手术的72例患者为研究对象,采用随机数字表法分为对照组和观察组,各36例。对照组采用全麻,观察组在对照组基础上采用罗哌卡因复合亚甲蓝椎旁神经阻滞麻醉,比较两组不同时间[入室时(T1)、切皮前(T2)、切皮后1 min(T3)、关胸(T4)、拔管后30 min(T5)]心率(HR)、平均动脉压(MAP)及疼痛评分、术后拔管时间、下床活动时间、围术期不良反应发生率。结果两组T2时HR、MAP均低于T1时,T3、T4、T5时HR、MAP均高于T2时,且观察组HR、MAP均低于对照组(P<0.05);观察组术后6、12、24、48 h疼痛评分均低于对照组(P<0.05);观察组术后拔管时间、下床活动时间均短于对照组(P<0.05);观察组围术期不良反应发生率为8.33%,低于对照组的16.67%(P<0.05)。结论罗哌卡因复合亚甲蓝椎旁阻滞在胸腔镜肺段切除手术具有良好的镇痛效果,对患者血流动力学影响小,可维持HR、MAP基本稳定。同时患者术后拔管时间、下床活动时间短,围术期不良反应少,具有相对更优的安全性和有效性。

Objective To study the effect of ropivacaine combined with methylene blue paravertebral block on hemodynamics and postoperative analgesia in patients undergoing thoracoscopic segmentectomy.Methods A total of 72 patients who underwent thoracoscopic segmentectomy in our hospital from May 2020 to May 2022 were selected as the research objects.They were divided into control group and observation group by random number table method,with 36 patients in each group.The control group was treated with general anesthesia,and the observation group was treated with ropivacaine combined with methylene blue paravertebral nerve block anesthesia on the basis of the control group.The heart rate(HR)and mean arterial pressure(MAP)at different times[entering the room(T1),before skin incision(T2),1 min after skin incision(T3),chest closure(T4),30 min after extubation(T5)],pain score,postoperative extubation time,time to get out of bed,and incidence of perioperative adverse reactions were compared between the two groups.Results The HR and MAP at T2 in the two groups were lower than those at T1,and the HR and MAP at T3,T4 and T5 were higher than those at T2,and the HR and MAP in the observation group were lower than those in the control group(P<0.05).The pain scores of the observation group at 6,12,24,48 h after operation were lower than those of the control group(P<0.05).The postoperative extubation time and ambulation time in the observation group were shorter than those in the control group(P<0.05).The incidence of perioperative adverse reactions in the observation group was 8.33%,which was lower than 16.67%in the control group(P<0.05).Conclusion Ropivacaine combined with methylene blue paravertebral block has a good analgesic effect in thoracoscopic segmentectomy.It has little effect on hemodynamics and can maintain HR and MAP stable.At the same time,the patient's postoperative extubation time and ambulation time are short,and the perioperative adverse reactions are less,which has relatively better safety and effectiveness.