氢吗啡酮复合罗哌卡因椎旁神经阻滞在胸腔镜手术中的应用效果

Application effect of hydromorphone combined with ropivacaine paravertebral nerve block in thoracoscopic surgery

目的:探讨氢吗啡酮复合罗哌卡因椎旁神经阻滞在胸腔镜手术中的应用效果。方法:将2021年3月至2023年3月行胸腔镜手术的90例患者随机分为对照组与研究组,每组45例。对照组予以罗哌卡因行椎旁神经阻滞麻醉,研究组在对照组的基础上予以氢吗啡酮注射液,比较两组麻醉效果及患者血流动力学变化情况。结果:研究组与对照组术后6 h疼痛视觉模拟评分[(1.43±0.23)分vs.(2.58±0.51)分,P<0.05]、12 h疼痛评分[(2.15±0.29)分vs.(3.34±0.63)分,P<0.05]、麻醉诱导后平均动脉压[(77.68±8.30)mmHg vs.(72.31±8.11)mmHg,P<0.05]、手术结束时平均动脉压[(85.25±8.82)mmHg vs.(80.99±8.36)mmHg,P<0.05]、麻醉诱导后心率[(67.08±7.02)次/min vs.(62.15±6.82)次/min,P<0.05]、手术结束时心率[(73.62±7.83)次/min vs.(67.34±7.04)次/min,P<0.05]、椎旁神经阻滞镇痛持续时间[(1 272.76±166.82)min vs.(654.02±82.13)min,P<0.05]、自控镇痛泵按压次数[(2.66±0.85)次vs.(5.22±1.16)次,P<0.05]、术后48 h氢吗啡酮用量[(5.26±1.02)mg vs.(6.46±1.38)mg,P<0.05]、不良反应中呕吐发生率(4.44%vs. 22.22%,P<0.05)差异均有统计学意义。结论:氢吗啡酮复合罗哌卡因椎旁神经阻滞在胸腔镜手术中具有较好的镇痛效果,能显著减轻患者术后疼痛,维持术中血流动力学稳定,延长神经阻滞时间。

Objective:To investigate the application effect of hydromorphone combined with ropivacaine paravertebral nerve block in thoracoscopic surgery.Methods:A total of 90 patients who underwent thoracoscopic surgery from Mar.2021 to Mar.2023 were randomly divided into control group and study group,with 45 cases in each group.Control group received ropivacaine for paravertebral nerve block anesthesia,while study group received hydromorphone injection based on control group.The anesthesia effects and hemodynamic changes of the two groups were compared.Results:There were significant differences between the study group and the control group in pain visual analogue score at 6 h after surgery[(1.43±0.23)points vs.(2.58±0.51)points,P<0.05]and 12 h after s urgery[(2.15±0.29)points vs.(3.34±0.63)points,P<0.05],mean arterial pressure after anesthesia induction[(77.68±8.30)mmHg vs.(72.31±8.11)mmHg,P<0.05]and at the end of surgery[(85.25±8.82)mmHg vs.(80.99±8.36)mmHg,P<0.05],heart rate after anesthesia induction[(67.08±7.02)beats/min vs.(62.15±6.82)beats/min,P<0.05]and at the end of surgery[(73.62±7.83)beats/min vs.(67.34±7.04)beats/min,P<0.05],the duration of paravertebral nerve block analgesia[(1272.76±166.82)min vs.(654.02±82.13)min,P<0.05],the compression times of patient controlled intravenous analgesia[(2.66±0.85)vs.(5.22±1.16),P<0.05],the postoperative 48 h dosage of hydromorphone[(5.26±1.02)mg vs.(6.46±1.38)mg,P<0.05],the incidence of vomiting in adverse reactions(4.44%vs.22.22%,P<0.05).Conclusions:Hydromorphone combined with ropivacaine paravertebral nerve block has good analgesic effect in thoracoscopic surgery,which can obviously reduce postoperative pain,maintain i ntraoperative hemodynamic stability,and prolong nerve block time.