不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在非气管插管肺大疱微创切除术中的应用比较

Comparison of different doses of dexmedetomidine combined with ropivacaine for thoracic paravertebral nerve block in minimally invasive pulmonary bullae resection for non-endotracheal intubation

目的探讨非气管插管肺大疱微创切除术中右美托咪定给药剂量差异对感觉阻滞效果及安全性的影响。方法选择2017年1月—2019年12月收治行非气管插管肺大疱微创切除术患者共160例,根据随机数字表分为四组,每组40例,A组单纯给予罗哌卡因(0.375%)20 mL椎旁神经阻滞,B、C及D组分别在A组基础上加用右美托咪定0.5μg/kg、1.0μg/kg及2.0μg/kg椎旁神经阻滞;比较四组患者生命体征指标、感觉阻滞时间、术中麻醉药物用量及安全性指标。结果C、D组T2和T3时间点PaCO_(2)水平均显著低于A组(P<0.05);同时C、D组T2和T3时间点RR和PaCO_(2)水平均显著高于A组(P<0.05)。B、C及D组感觉阻滞起效时间显著短于A组,感觉阻滞持续时间显著长于A组(P<0.05);C、D组感觉阻滞起效时间显著短于B组,感觉阻滞持续时间显著长于B组(P<0.05);C、D组术中麻醉药物用量均显著少于A组(P<0.05)。D组低血压、心动过缓及接受阿托品治疗比例均显著高于其他三组(P<0.05)。结论非气管插管肺大疱微创切除术中右美托咪定1.0μg/kg剂量复合0.375%罗哌卡因可有效提高感觉阻滞效果,减少麻醉药物用量,且安全性良好。

Objective To investigate the effect of different doses of dexmedetomidine on clinical efficacy and safety of sensory block in minimally invasive pulmonary bullae resection for non-endotracheal intubation.Methods 160 patients who underwent minimally invasive pulmonary bullae resection for non-endotracheal intubation from January 2017 to December 2019 were selected.All patients were randomly divided into 4 groups,with 40 cases in each group.Group A were given 20 mL of ropivacaine(0.375%)alone,and group B,group C and group D were respectively given 0.5μg/kg,1.0μg/kg and 2.0μg/kg of dexmedetomidine on the basis of the group A for paravertebral nerve block.And then,vital signs,sensory block time,the amount of anesthetic drugs and safety indexes of the 4 groups were compared.Results PaCO_(2)levels at T2 and T3 time points in the group C and the group D were significantly lower than those in the group A(P<0.05),and the levels of RR and PaO_(2)at T2 and T3 in the group C and the group D were significantly higher than those in the group A(P<0.05).The onset time of sensory block in the group B,the group C and the group D was significantly shorter than that in the group A,and duration of sensory block was significantly longer than that in the group A(P<0.05).The onset time of sensory block in the group C and the group D was significantly shorter than that in the group B,and the duration of sensory block was significantly longer than that in the group B(P<0.05).The amount of anesthetic drugs in the group C and the group D was significantly less than that in the group A(P<0.05).The proportions of hypotension,bradycardia and atropine treatment in the group D were significantly higher than those in the other three groups(P<0.05).Conclusion Dexmedetomidine(1.0μg/kg)combined with ropivacaine(0.375%)can effectively improve the effect of sensory block and reduce the amount of anesthetic drugs in minimally invasive pulmonary bullae resection for non-endotracheal intubation,with satisfactory safety.