文章摘要
右美托咪定复合罗哌卡因胸椎旁神经阻滞对胸腹腔镜联合食管癌根治术术后恢复质量的影响
Effect of postoperative quality of recovery after thoracic laparoscopy combined with radical esophagectomy of esophageal cancer by using dexmedetomidine combined with ropivacaine
  
DOI：10.12089/jca.2021.05.001
中文关键词: 右美托咪定  胸椎旁神经阻滞  胸腹腔镜  食管癌根治术  恢复质量  炎症反应
英文关键词: Thoracic paraspinal nerve block  Quality of receovery  Dexmetomidine  Inflammatory response  Thoracic laparoscopy  Radical esophagectomy of esophageal cancer
基金项目:安徽省自然科学基金（1908085MH251）
作者单位E-mail
乔迁 230036,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
康芳 230036,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
黄祥 230036,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
郝利娜 230036,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
李娟 230036,中国科学技术大学附属第一医院,安徽省立医院麻醉科 huamuzi1999@126.com 
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中文摘要:
      
目的 探讨右美托咪定复合罗哌卡因胸椎旁神经阻滞（TPVB）对胸腹腔镜联合食管癌根治术患者术后恢复质量的影响。
方法 选择2020年6—12月全麻下择期行胸腹腔镜联合食管癌根治术的患者60例，男32例，女28例，年龄50~70岁，BMI 20~25 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：右美托咪定复合罗哌卡因TPVB组（TD组）和罗哌卡因TPVB组（TS组），每组30例。麻醉诱导前15 min，两组分别在超声引导下行右侧T6水平椎旁神经阻滞，TD组注入右美托咪定1 μg/kg和0.375%罗哌卡因的混合液20 ml，TS组注入0.375%罗哌卡因20 ml。两组麻醉诱导和麻醉维持方法一致，术毕均实施PCIA。采用QoR-40量表评价患者术前1 d、术后3 d和术后1个月的恢复质量。分别在麻醉诱导后5 min、进胸时和术后24 h采集患者静脉血2 ml，检测血浆IL-6、IL-8浓度。记录手术时间、麻醉时间、术中丙泊酚和瑞芬太尼用量、术后4、8、12、24 h静息和运动时VAS疼痛评分、术后24 h补救镇痛例数、术后并发症发生情况。
结果 与术前1 d比较，术后3 d TS组QoR-40量表评分明显降低（P<0.05）。与麻醉诱导后5 min比较，进胸时、术后24 h TD组和TS组血浆IL-6，IL-8浓度均明显升高（P<0.05）。与TS组比较，TD组术后3 d、1个月时QoR-40量表评分明显增高（P<0.05），进胸时、术后24 h血浆IL-6，IL-8浓度均明显降低（P<0.05），术中瑞芬太尼用量明显减少（P<0.05），术后4、8、12、24 h静息和运动时VAS疼痛评分明显降低（P<0.05），术后24 h补救镇痛例数明显减少（P<0.05）。两组肺部感染及肺不张发生率差异无统计学意义。
结论 右美托咪定1 μg/kg复合罗哌卡因胸椎旁神经阻滞可以减轻胸腹腔镜联合食管癌根治术患者术后疼痛，减轻围术期手术炎症反应，减少术中镇痛药物用量，提高患者术后恢复质量。
英文摘要:
      
Objective To investigate the effect of dexmedetomidine combined with ropivacaine thoracic paraspinal nerve block (TPVB) on postoperative recovery quality in patients after thoracic laparoscopy combined with radical esophagectomy of esophageal cancer.
Methods Sixty patients underwent thoracic laparoscopic combined radical resection of esophageal cancer under general anesthesia from June 2020 to December 2020 were enrolled, 32 males and 28 females, aged 50-70 years, BMI 20-25 kg/m2, ASA physical status Ⅰ or Ⅱ, were divided into two groups: dexmedetomidine combined with ropivacaine TPVB group (group TD) and ropivacaine TPVB group (group TS), 30 patients in each group. Both groups done T6 right lateral paravertebral nerve block under ultrasound guidance 15 minutes before general anesthesia, group TD was injected 20 ml mixture liquids of dexmedetomidine 1 μg/kg and 0.375% ropivacaine, group TS injected 20 ml of 0.375% ropivacaine. The methods of induction and maintenance of anesthesia were consistent, PCIA were all implemented at the end of operation. QoR-40 scale was used to evaluate the recovery quality of patients 1 day before operation, 3 days and 1 month after operation. Venous blood 2 ml were collected 5 minutes after induction of anesthesia, during thoracotomy and 24 hours after operation to detect the concentration of serum IL-6 and IL-8. Duration of operation, anesthesia time, propofol and remifentanil dosage during operation, the VAS scores at rest and during exercise 4, 8, 12, and 24 hours after operation, patients number of rescue analgesia 24 hous after operation, and postoperative complications were all recorded.
Results Compared with 1 day before operation, the scores of QoR-40 scale decreased significantly 3 days after operation in group TS (P < 0.05). Compared with 5 minutes after induction of anesthesia, the plasma concentrations of IL-6 and IL-8 in groups TD and TS were significantly increased at the time of thoracotomy and 24 hours after operation (P < 0.05). Compared with group TS, the scores of QoR-40 in group TD were significantly higher 3 days and 1 month after operation (P < 0.05), the plasma concentrations of IL-6 and IL-8 in group TD were significantly decreased at the time of entering chest and 24 hours after operation (P < 0.05), the dosage of remifentanil during operation in group TD was significantly reduced (P < 0.05), the VAS scores at rest and during exercise 4, 8, 12 and 24 hours after operation in group TD were significantly decreased (P < 0.05), the number of cases of rescue analgesia 24 hours after operation in group TD was significantly reduced (P < 0.05). There were no differences in the incidence of pulmonary infection and atelectasis between groups TD and TS.
Conclusion Dexmedetomidine 1 μg/kg combined with ropivacaine can relieve postoperative pain, reduce perioperative inflammatory reaction, reduce the dosage of intraoperative analgesics and improve the quality of postoperative recovery in patients undergoing thoracic laparoscopic combined with radical resection of esophageal cancer.
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