文章摘要
超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜交感神经切断术
Application of ultrasound guided thoracic paravertebral blockade combined with dexmedetomidine in thoracoscopic sympathectomy
  
DOI：
中文关键词: 胸椎旁阻滞  右美托咪定  非气管内插管  胸腔镜下胸交感神经切断术
英文关键词: Thoracic paravertebral blockade  Dexmedetomidine  Nontracheal intubation  Sympathectomy with video-assisted thoracic surgery
基金项目:贝朗麻醉科学研究基金(Z022016001)
作者单位E-mail
徐金东 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
韦锦锋 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
郁丽娜 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
王庆 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
王志鹏 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
郭远波 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科  
王晟 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 shengwang_gz@163.com 
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中文摘要:
      
目的：观察超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜下胸交感神经切断术的麻醉效果。
方法：选择择期行胸腔镜下胸交感神经切断术患者80例, 男38例, 女42例, 年龄16～28岁, ASA Ⅰ或Ⅱ级, 按随机数字表法分为研究组和对照组, 每组40例。研究组在行胸椎旁阻滞前15 min静脉泵注右美托咪定, 负荷剂量0.5 μg/kg (4 μg/ml), 10 min内泵完, 并以0.3～0.5 μg·kg-1·h-1持续泵至术毕;对照组以同样方式输注等容量生理盐水。观察并记录患者入室(T0)、胸椎旁阻滞穿刺后(T1)、切皮(T2)、交感神经切断(T3)、手术结束(T4)时的HR、RR、MAP、SpO2和警觉/镇静评分(OAA/S), 记录不良反应的发生情况。
结果：与对照组比较, T1～T4时研究组HR明显减慢, MAP明显降低(P＜0.05);T2、T3时研究组RR明显增快(P＜0.05)。T1～T3时研究组OAA/S评分明显低于对照组(P＜0.05)。研究组和对照组术后恶心呕吐分别1例和2例, 两组差异无统计学意义。
结论：超声引导下胸椎旁阻滞复合静脉右美托咪定应用于胸腔镜下胸交感神经节切断术是安全有效的。
英文摘要:
      
Objective: To evaluate the anesthetic effect of ultrasound guided thoracic paravertebral blockade combined with intravenous dexmedetomidine in thoracoscopic sympathectomy.
Methods: Eighty patients (38 male and 42 female) undergoing selected thoracoscopic sympathectomy, aged from 16 to 28 years, in ASA physical status Ⅰ or Ⅱ, were equally divided into study group and control group, 40 patients in each, according to random number table. Fifteen minutes before paravertebral blockade, while study group received loading dose (0.5 μg/kg) of dexmedetomidine (4 μg/ml) intravenously within 10 min and eceived continuous intravenous pumping (0.3-0.5 μg·kg-1·h-1) throughout the operation, control group received isovolumetric normal saline in the same pattern. Patients’ heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), SpO2, observer's assessment of alertness/sedation (OAA/S) scale and adverse reactions were recorded in several time points, namely timing of entrance (T0), timing of paravertebral blockade (T1), timing of skin incision (T2), timing of sympathectomy (T3) and the end (T4), respectively.
Results: Compared to the control group, while MAP and HR in the study group were obviously decreased through T1-T4 (P＜0.05), RR was obvious increased in T2 and T3 (P＜0.05) and OAA/S scale was obviously lowered in the study group (P＜0.05). The study group and the control group had one case and two cases of adverse reaction, respectively, with no significant difference between the two groups.
Conclusion: The application of ultrasound guided thoracic paravertebral blockade combined with intravenous dexmedetomidine in thoracoscopic sympathectomy is safe and effective.
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