超声引导右美托咪定结合罗哌卡因胸椎旁神经阻滞在开胸手术患者围术期镇痛中的应用效果

Application effect of ultrasound-guided dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block in perioperative analgesia for patients undergoing thoracotomy

目的探讨超声引导右美托咪定结合罗哌卡因胸椎旁神经阻滞在开胸手术患者围术期镇痛中的应用效果。方法选取我院2021年1月至2022年4月收治的40例开胸手术患者为研究对象,按照随机数字表法将其分为常规组(超声引导罗哌卡因胸椎旁神经阻滞)和观察组(超声引导右美托咪定结合罗哌卡因胸椎旁神经阻滞),各20例。比较两组的麻醉效果。结果麻醉后5 min(T_(1))至术后即刻(T_(3)),观察组的心率(HR)、脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)、呼吸频率(RR)高于常规组,差异具有统计学意义(P<0.05);观察组在麻醉过程中的HR、SpO_(2)、MAP、RR波动幅度较小;麻醉前(T_(0))至T_(3),两组的脑电双频谱指数(BIS)比较,差异无统计学意义(P>0.05)。观察组的心动过缓、呼吸抑制、恶心呕吐发生率低于常规组,差异具有统计学意义(P<0.05);两组的低血压、头晕发生率比较,差异无统计学意义(P>0.05)。观察组的感觉阻滞起效时间短于常规组,感觉阻滞持续时间、镇痛持续时间长于常规组,差异具有统计学意义(P<0.05);术后6 h,观察组的视觉模拟评分法(VAS)评分低于常规组(P<0.05)。结论超声引导右美托咪定结合罗哌卡因胸椎旁神经阻滞在开胸手术患者围术期镇痛中的应用效果良好,可稳定生命体征,保障麻醉效果,提升麻醉安全性。

Objective To explore the application effect of ultrasound-guided dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block in perioperative analgesia for patients undergoing thoracotomy.Methods A total of 40 patients undergoing thoracotomy in our hospital from January 2021 to April 2022 were selected as the research objects.According to the random number table method,the patients were divided into routine group(ultrasound-guided ropivacaine thoracic paravertebral nerve block)and observation group(ultrasound-guided dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block),with 20 cases in each group.The anesthesia effects of the two groups were compared.Results From 5 min after anesthesia(T_(1))to immediately after operation(T_(3)),the heart rate(HR),pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP)and respiratory rate(RR)of the observation group were higher than those of the routine group,and the differences were statistically significant(P<0.05);the fluctuation range of HR,SpO_(2),MAP and RR in the observation group during anesthesia was small;from before anesthesia(T_(0))to T_(3),there was no significant difference in bispectral index(BIS)between the two groups(P>0.05).The incidences of bradycardia,respiratory depression,nausea and vomiting in the observation group were lower than those in the routine group,and the differences were statistically significant(P<0.05);there were no significant differences in the incidences of hypotension and dizziness between the two groups(P>0.05).The onset time of sensory block in the observation group was shorter than that in the routine group,and the duration of sensory block and analgesia were longer than those in the routine group,and the differences were statistically significant(P<0.05);at 6 h after operation,the Visual Analogue Score(VAS)score of the observation group was lower than that of the routine group,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block has a good application effect in perioperative analgesia for patients undergoing thoracotomy.It can stabilize vital signs,ensure anesthesia effect,and improve anesthesia safety.