非体外循环冠状动脉搭桥术患者胸椎旁神经阻滞中应用罗哌卡因联合右美托咪定的麻醉效果观察

Anesthesia effect of ropivacaine combined with dexmedetomidine in thoracic paravertebral nerve block for patients undergoing off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉搭桥术(OPCABG)患者胸椎旁神经阻滞(TPVB)中应用罗哌卡因联合右美托咪定的麻醉效果。方法选取2019年8月—2021年12月在该院实施OPCABG术的96例患者,采用随机数字表法将患者分为观察组和对照组,每组48例。二组患者均采用TPVB,对照组予以罗哌卡因,观察组予以罗哌卡因联合右美托咪定。观察二组患者住重症监护室(ICU)时间、住院时间、苏醒时间、拔管时间和术后舒芬太尼用量。分别于麻醉诱导前后,记录患者不同时间点的心率(HR)、呼吸(RR)、平均动脉压(MAP)和经皮血氧饱和度(SPO_(2));采用视觉模拟评分(VAS)和Ramsay镇静评分表评估患者不同时间点的疼痛和镇静效果;于术前和术后24h对比二组应激反应[肾上腺素(E)、去甲肾上腺素(NE)]变化情况;并记录患者不良反应的发生情况。结果观察组患者住ICU时间、住院时间、拔管时间和苏醒时间均优于对照组,术后舒芬太尼用量少于对照组(P<0.05);在T1的时候,观察组的HR、RR、MAP、SPO_(2)水平与对照组相比差异无统计学意义(P>0.05),在T2、T3、T4时观察组的HR、RR、MAP、SPO_(2)水平均显著低于对照组(P<0.05);在术后2h、6h、12h,观察组的VAS评分及Ramsay的评分均显著低于对照组(P<0.05)。术后24h观察组E、NE水平均低于对照组(P<0.05)。观察组不良反应发生率为8.33%,与对照组的14.58%相比差异无统计学意义(P>0.05)。结论OPCABG术患者TPVB中应用罗哌卡因联合右美托咪定的麻醉效果较好,可起到良好的镇痛镇静作用,有利于维持血流动力学稳定,减轻因手术引起的应激反应,促进患者早期康复。

Objective To explore the anesthesia effect of ropivacaine combined with dexmedetomidine in thoracic paravertebral nerve block(TPVB)for patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of ninety-six patients undergoing OPCABG in the hospital were enrolled between August 2019 and December 2021.According to random number table method,they were divided into observation group and control group,48 cases in each group.All underwent TPVB.After that,control group was given ropivacaine,while observation group was given ropivacaine and dexmedetomidine.The stay time in intensive care unit(ICU),hospitalization time,awakening time,extubation time and postoperative sufentanil dosage in both groups were observed.Before and after anesthesia induction,heart rate(HR),respiration(RR),mean arterial pressure(MAP)and transcutaneous oxygen saturation(SPO_(2))at different time points were recorded.The pain and sedative effect were evaluated by visual analogue scale(VAS)and Ramsay sedation scale.The changes of stress responses[epinephrine(E),norepinephrine(NE)]before and at 24h after surgery in the two groups were compared.The occurrence of adverse reactions was recorded.Results Th stay time in ICU,hospitalization time,extubation time and awakening time in observation group were better than those in control group,and postoperative sufentanil dosage was fewer than that in control group(P<0.05).At T1,there was no significant difference in HR,RR,MAP or SPO_(2) between the two groups(P>0.05).At T2,T3 and T4,levels of HR,RR,MAP and SPO_(2) in observation group were significantly lower than those in control group(P<0.05).At 2h,6h and 12h after surgery,VAS and Ramsay scores in observation group were significantly lower than those in control group(P<0.05).At 24h after surgery,levels of E and NE in observation group were lower than those in control group(P<0.05).There was no significant difference in incidence of adverse reactions between observation group and control group(8.33%vs.14.58%,P>0.05).Conclusion The anesthesia effect of ropivacaine combined with dexmedetomidine in TPVB is good for OPCABG patients,which has good analgesic and sedative effect,and is beneficial to maintain hemodynamic stability,alleviate surgery-induced stress responses and promote early recovery of patients.