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| 右美托咪定对罗哌卡因前锯肌平面阻滞半数有效浓度的影响 |
| Effect of dexmedetomidine on median effective concentration of ropivacaine for serratus anterior plane block |
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| DOI：10.12089/jca.2021.10.004 |
| 中文关键词: 前锯肌平面阻滞 右美托咪定 罗哌卡因 半数有效浓度 |
| 英文关键词: Serratus anterior plane block Dexmedetomidine Ropivacaine Median effective concentration |
| 基金项目:广东省医学科学技术研究基金(B2018001);揭阳市卫生医疗类项目(YLWS005) |
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| 中文摘要: |
目的 探讨右美托咪定作为佐剂对罗哌卡因前锯肌平面阻滞(SAPB)半数有效浓度(EC50)的影响。
方法 选择择期行胸腔镜下肺叶或肺段切除术患者44例,男26例，女18例，年龄40～64岁,BMI 18.5～24.0 kg/m2,ASA Ⅰ或Ⅱ级。随机分为两组:右美托咪定复合罗哌卡因组(DR组,n=21)和罗哌卡因组(R组,n=23)。两组均在超声引导下行SAPB,DR组注入含右美托咪定1.0 μg/kg的罗哌卡因混合溶液30 ml,R组注入罗哌卡因30 ml。罗哌卡因初始浓度为0.4％,按照序贯法确定下一例罗哌卡因浓度,相邻浓度比值为1.1。若上一例阻滞效果评定为良好,则下一例采用低1个等级的浓度,反之则采用高1个等级的浓度,获得7个上下交叉点后结束试验。采用Probit回归分析计算罗哌卡因的EC50及其95％CI。记录神经阻滞前和神经阻滞后10、20、30 min的MAP、HR、麻醉趋势指数(NI)和Ramsay镇静评分。神经阻滞前以及神经阻滞后30 min,采用视觉模拟焦虑量表评估焦虑程度。记录神经阻滞后30 min内心动过缓、低血压、镇静过度、呼吸抑制、恶心呕吐、局麻药中毒、局部血肿、气胸等不良反应的发生情况。
结果 DR组和R组罗哌卡因EC50分别为0.26％(95%CI 0.23％～0.28％)和0.32％(95%CI 0.30％～0.34％)。与R组比较,神经阻滞后30 min DR组MAP明显降低,HR明显减慢(P<0.05)。与R组比较,神经阻滞后20、30 min DR组NI明显降低,Ramsay镇静评分明显升高(P<0.05)。与R组比较，神经阻滞后30 min DR组视觉模拟焦虑评分明显降低(P<0.05)。两组均未发生严重不良反应。
结论 右美托咪定可降低罗哌卡因前锯肌平面阻滞的EC50,提供有效的镇静和抗焦虑作用,较好地维持血流动力学的稳定。 |
| 英文摘要: |
Objective To investigate the effect of dexmedetomidine as an adjuvant on the median effective concentration (EC50) of ropivacaine for serratus anterior plane block (SAPB).
Methods Forty-four patients undergoing elective thoracoscopic lobectomy or thoracoscopic segmentectomy, 26 males and 18 females, aged 40-64 years, BMI 18.5-24.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were included into this study. The patients were assigned randomly into either the ropivacaine combined with dexmedetomidine group (group DR, n = 21) or ropivacaine group (group R, n = 23). Patients received ultrasound-guided serratus anterior plane block in both groups, 30 ml mixed solution of ropivacaine containing dexmedetomidine 1.0 μg/kg was injected in group DR, and 30 ml solution of ropivacaine was injected in group R. The initial concentration of ropivacaine was 0.4% and the next concentration of ropivacaine was determined by sequential method. The ratio of two adjacent concentrations was 1.1. If the block was assessed to be effective, a lower concentration of ropivacaine was used in the next patient, otherwise, a higher concentration of ropivacaine was used. The experiment was ended by reaching seven upper and lower intersection points. Probit regression analysis was used to calculate the EC50 (95% CI) of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), Narcotrend index (NI), Ramsay sedation score were recorded before nerve block and 10, 20, 30 minutes after nerve block. Visual analogue anxiety scale was recorded before nerve block and 30 minutes after nerve block. Bradycardia, hypotension, excessive sedation, respiratory depression, nausea and vomiting, local anesthetic poisoning, local hematoma, pneumothorax, and other adverse reactions were recorded within 30 minutes after nerve block.
Results The EC50 of ropivacaine in group DR and group R were 0.26% (95% CI 0.23%-0.28%) and 0.32% (95% CI 0.30%-0.34%), respectively. Compared with group R, MAP and HR in group DR were significantly decreased 30 minutes after nerve block (P < 0.05). Compared with group R, NI in group DR was significantly decreased 20 and 30 minutes after nerve block, while Ramsay score was significantly increased (P < 0.05). The visual analogue anxiety score in group DR was lower than that in group R 30 minutes after nerve block (P < 0.05). There were no severe adverse reactions in the two groups.
Conclusion Dexmedetomidine significantly decreasing the EC50 of ropivacaine for serratus anterior plane block, provides effective sedative and anxiolytic effects and maintains the hemodynamic stability well. |
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