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| 右美托咪定不同给药途径对胸腔镜肺叶切除术后肋间神经阻滞的影响 |
| Effect of different administration routes of dexmedetomidine in intercostal nerve block after thoracoscopic lobectomy |
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| DOI：10.12089/jca.2019.05.003 |
| 中文关键词: 肋间神经阻滞 右美托咪定 术后镇痛 胸腔镜肺叶切除术 |
| 英文关键词: Intercostal nerve block Dexmedetomidine Postoperative analgesia Thoracoscopic lobectomy |
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| 中文摘要: |
目的 比较右美托咪定不同给药途径对肋间神经阻滞（INB）作用时间的影响。
方法 择期行胸腔镜下肺叶切除术患者60例，年龄28～69岁，BMI 18～23 kg/m2，ASA I或Ⅱ级，随机分为三组，每组20例。手术结束关闭胸腔前在胸腔镜直视下行INB。C组：生理盐水1 ml+0.5%罗哌卡因29 ml行INB，生理盐水50 ml静脉输注；Div组：生理盐水1 ml+0.5%罗哌卡因29 ml行INB，右美托咪定1 μg/kg用生理盐水稀释到50 ml静脉输注；Dp组：右美托咪定1 μg/kg用生理盐水稀释到1 ml+0.5%罗哌卡因29 ml行INB，生理盐水50 ml静脉输注。术后患者均行PCIA。记录INB镇痛作用持续时间、术后PCIA芬太尼的消耗量；记录术后48 h PCIA有效和无效按压次数；记录手术时间、拔管时间以及术后恶心呕吐、皮肤瘙痒、头晕等不良反应的发生情况。
结果 与C组（440.0±109.6）min比较，Div组(519.0±82.5)min和Dp组(602.5±108.5)min镇痛作用时间明显延长（P<0.05）。术后PCIA芬太尼消耗量C组为（369.0±134.1）μg，Div组为(268.5±93.0)μg，Dp组为(237.0±98.7)μg，与C组比较，Div组和Dp组术后PCIA芬太尼消耗量明显减少（P﹤0.05）。与C组比较，Div组和Dp组术后48 h PCIA有效和无效按压次数明显减少（P﹤0.05或P﹤0.01）。C组有1例发生恶心呕吐，Div组和Dp组分别有1例发生头晕，三组恶心呕吐、头晕等不良反应差异无统计学意义。
结论 静脉和肋间使用右美托咪定可同等程度地延长胸腔镜肺切除术后肋间神经阻滞的镇痛作用时间，减少术后芬太尼消耗量。 |
| 英文摘要: |
Ojective To compare the effects of different administration routes of dexmedetomidine on the duration of intercostal nerve block (INB).
Methods Sixty patients received general anesthesia undergoing thoracoscopic lobectomy，aged 28 - 69 years,with a BMI 18 - 23 kg/m2, falling into ASA physical status Ⅰ or Ⅱ,were randomly allocated into three groups (n=20, each group). At the end of the surgery, the INB was performed under the thoracoscopic direct vision. Group C: 1 ml normal saline + 0.5% ropivacaine 29 ml for INB, and 50 ml normal saline for intravenous infusion; group Div: 1 ml normal saline + 0.5% ropivacaine 29 ml for INB, and 1 μg/kg dexmedetomidine dilute to 50 ml with normal saline for intravenous infusion; group Dp: 1 μg/kg dexmedetomidine (dilute to 1 ml with normal saline) + 0.5% ropivacaine 29 ml for INB, and 50 ml normal saline for intravenous infusion. All patients received PCIA for postoperative analgesia. The duration of analgesia and total postoperative PCIA fentanyl consumption were recorded. The effective pressing times and invalid pressing times of PCIA were recorded. Adverse effects such as respiratory depression were also recorded.
Results The duration of analgesia were longer in groups Div (519.0 ± 82.5) min and group Dp (602.5 ± 108.5) min compared with group C (440.0 ± 109.6) min (P < 0.05). PCIA fentanyl consumption was less in group Div (268.5 ± 93.0) μg and group Dp (237.0 ± 98.7) μg than in group C (369.0 ± 134.1) μg (P < 0.05 ). At postoperative 48 h, in groups Div and Dp the effective pressing times and invalid pressing times of PCIA were significantly less than that in group C (P < 0.05 or P < 0.01). There was 1 case of nausea in group C, and 1 case of dizziness in groups Div and Dp, respectively, with no significant difference.
Conclusion Intravenous and perineural dexmedetomidine can almost equally prolong the INB analgesic duration and reduce the opioid consumption in patients undergoing thoracoscopic lobectomy. |
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