不同剂量右美托咪定联合罗哌卡因对胸腔镜肺部手术患者麻醉效果、围手术期应激和睡眠质量的影响

Effect of different doses of dexmedetomidine combined with ropivacaine on anesthesia,perioperative stress,and sleep quality in patients undergoing thoracoscopic lung surgery

目的探讨不同剂量的右美托咪定联合罗哌卡因进行胸椎旁神经阻滞对胸腔镜肺部手术患者的镇痛效果、术后应激反应、炎性反应及睡眠质量的影响。方法选取2022年3月—2023年1月在我院行胸腔镜肺部手术的患者98例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级。依据治疗方法将其分为研究组(43例)和对照组(55例)。两组患者均予以全麻诱导后行胸椎旁神经阻滞,研究组使用低剂量右美托咪定(0.5μg·kg-1)联合0.375%罗哌卡因,对照组使用高剂量右美托咪定(1.0μg·kg-1)联合0.375%罗哌卡因。采用视觉模拟量表(VAS)评估术后疼痛程度;采用酶联免疫吸附试验(ELISA)法测定术前及术后不同时间点白细胞介素6(IL-6)、C反应蛋白(CRP)浓度;采用匹兹堡睡眠质量指数(PSQI)评估患者睡眠质量;并记录不良反应发生情况。结果术后1 h,研究组和对照组VAS评分差异无统计学意义(P>0.05);术后6~48 h,两组患者VAS评分均高于术后1 h(均P<0.05),且研究组患者术后12 h、24 h、48 h的VAS评分均高于对照组(均P<0.05)。两组患者术后血清IL-6、CRP浓度均高于术前(均P<0.05),且在术前和术后,两组间比较均差异无统计学意义(均P<0.05)。两组患者PSQI评分术后均较术前升高(P<0.05),但组间差异无统计学意义(P>0.05)。研究组术后总并发症发生率较对照组低[2.3%(1/43),16.4%(9/55),P<0.05]。结论高剂量右美托咪定联合罗哌卡因能够更好地控制术后疼痛,但低剂量右美托咪定联合罗哌卡因对手术应激、炎性反应的影响较小,且术后并发症发生率低。

Objective To explore the analgesic effect,postoperative stress response,inflammatory response,and sleep quality of thoracic paravertebral nerve block with different doses of dexmedetomidine combined with ropivacaine in patients undergoing thoracoscopic lung surgery.Methods A total of 98 patients with American Society of Anesthesiologists(ASA)grades of Ⅰ-Ⅲ undergoing thoracoscopic lung surgery in our hospital from March 2022 to January 2023 were selected.According to the treatment methods,they were divided into the study group(n=43)and the control group(n=55).All the patients in both groups received general anesthesia induction followed by thoracic paravertebral nerve block.Meanwhile,the patients in the the study one received low-dose dexmedetomidine(0.5μg·kg^(-1))combined with 0.375% ropivacaine and those in the control received high-dose dexmedetomidine(1.0μg·kg^(-1))combined with 0.375% ropivacaine.Visual Analog Scale(VAS)was used to evaluate the degree of postoperative pain.ELISA method was used to measure plasma Interleukin 6(IL-6)and C-reactive protein(CRP)concentrations at different time points before and after surgery.The sleep quality was evaluated using the Pittsburgh Sleep Quality Index(PSQI).The occurrence of adverse reactions was recorded.Results One hour after the operation,there was no difference in VAS scores between the 2 groups(P>0.05).From the 6th to 48th h after surgery,the VAS scores of the two groups were higher than those at 1 hour after operation(P<0.05),and the VAS scores of the study group at 12 h,24 h,and 48 h after operation were higher than those of the control group(P<0.05).The postoperative IL-6 and CRP levels increased compared to preoperative levels in both groups(P<0.05),and the differences between the two groups before and after operation were both significant(P>0.05).The PSQI scores of both groups increased after operation as compared with those before(P<0.05),but there was no statistically significant difference between the 2 groups(P>0.05).The overall incidence of postoperative complications in the study group(2.3%,1/43)was lower than that in the control(16.4%,9/55)(P<0.05).Conclusion High dose dexmedetomidine combined with ropivacaine can better control postoperative pain.However,the low-dose dexmedetomidine combined with ropivacaine has less impact on surgical stress and inflammatory response,and the incidence of postoperative complications is low.