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| 超声引导下罗哌卡因复合右美托咪定椎旁阻滞对单孔胸腔镜肺叶切除术患者术后慢性疼痛的影响 |
| Effect of ultrasound-guided ropivacaine combined with dexmedetomidine paravertebral block on chronic post-surgical pain in patients undergoing uniportal video-assisted thoracoscopic lobectomy surgery |
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| DOI：10.12089/jca.2026.07.002 |
| 中文关键词: 椎旁阻滞 术后慢性疼痛 右美托咪定 肺叶切除 炎性因子 |
| 英文关键词: Paravertebral block Chronic post-surgical pain Dexmedetomidine Lobectomy Inflammatory factors |
| 基金项目:苏州市科技发展计划项目（SYW2024082） |
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| 摘要点击次数: 143 |
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| 中文摘要: |
目的：探讨超声引导下罗哌卡因复合右美托咪定椎旁阻滞（PVB）对单孔胸腔镜肺叶切除术（UVATS）患者术后慢性疼痛（CPSP）的影响。
方法：选择择期行UVATS患者，年龄18～74岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：罗哌卡因复合右美托咪定组（RD组）和罗哌卡因组（R组）。两组在麻醉前行超声引导下PVB，RD组注射0.25%罗哌卡因0.35 ml/kg、右美托咪定1 μg/kg，R组注射0.25%罗哌卡因0.35 ml/kg。主要指标为术后3个月CPSP发生率。次要指标包括术后4、24、48 h NRS疼痛评分，麻醉诱导前、术后24 h血清白细胞介素-1β（IL-1β）、血清白细胞介素-6（IL-6）、肿瘤坏死因子-ɑ（TNF-α）浓度，术后24 h内及24～48 h补救镇痛率，胸管拔除时间、术后首次下床时间、术后住院时间、术后3个月神经病理性疼痛评分。不良反应为术后24 h恶心呕吐。
结果：共纳入患者102例，每组51例。与R组比较，RD组CPSP发生率、术后24、48 h NRS疼痛评分、IL-1β浓度明显降低，术后24~48 h补救镇痛率明显降低、术后住院时间明显缩短（P<0.05）。两组胸管拔除时间、术后首次下床时间、术后3个月神经病理性疼痛评分、术后24 h恶心呕吐发生率差异无统计学意义。
结论：超声引导下罗哌卡因复合右美托咪定PVB可有效降低UVATS患者术后3个月CPSP发生率，减轻术后急性疼痛，降低术后IL-1β浓度，缩短患者术后住院时间。 |
| 英文摘要: |
Objective: To investigate the effect of ultrasound-guided ropivacaine combined with the dexmedetomidine paravertebral block (PVB) on chronic post-surgical pain (CPSP) in patients undergoing uniportal video-assisted thoracoscopic lobectomy surgery (UVATS).
Methods: Patients scheduled for elective UVATS were enrolled, aged 18-74 years, with ASA Ⅰ or Ⅱ. Patients were randomly assigned into two groups using a random number table: the ropivacaine plus dexmedetomidine group (group RD) and the ropivacaine group (group R) . Group RD received 0.25% ropivacaine at 0.35 ml/kg combined with dexmedetomidine 1 μg/kg, while group R administered 0.25% ropivacaine at a dose of 0.35 ml/kg. The primary outcome was the incidence of CPSP at 3 months postoperatively. The secondary outcomes included the numerical rating scale (NRS) at postoperative 4, 24, and 48 hours, serum concentrations of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) preoperatively and 24 hours postoperatively, rescue analgesia rate within 24 hours postoperatively and during the 24-48 hours period, time to chest tube removal, time to first postoperative ambulation, length of postoperative hospital stays, neuropathic pain score at 3 months postoperatively. Adverse reaction was the incidence of postoperative nausea and vomiting (PONV) within 24 hours postoperatively.
Results: A total of 102 patients were enrolled in this study, 51 patients in each group. Compared with group R, group RD exhibited significantly lower incidence of CPSP, lower NRS pain scores at 24 and 48 hours postoperatively, as well as significantly lower postoperative IL-1β concentrations,a decreased incidence of rescue analgesia within 24-48 hours postoperatively, and shorter postoperative hospital stays (P<0.05). There were no statistically significant differences between the two groups regarding time to chest tube removal, time to first postoperative ambulation, neuropathic pain score at 3 months, or incidence of postoperative 24 hours PONV.
Conclusion: Ropivacaine combined with dexmedetomidine PVB can effectively reduce the incidence of CPSP at 3 months after UVATS, alleviate acute postoperative pain, decrease postoperative IL-1β , and shorten the length of postoperative hospital stays. |
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