[1]荆凤娥.超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞在老年胸腔镜肺癌根治术中的应用效果[J].新乡医学院学报,2024,(3):270-274.[doi:10.7683/xxyxyxb.2024.03.014]
　JING Fenge.Effect of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block in elderly thoracoscopic radical surgery for lung cancer[J].Journal of Xinxiang Medical University,2024,(3):270-274.[doi:10.7683/xxyxyxb.2024.03.014]
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超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞在老年胸腔镜肺癌根治术中的应用效果
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年3
页码:
270-274
栏目:
临床研究
出版日期:
2024-03-05

文章信息/Info

Title:
Effect of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block in elderly thoracoscopic radical surgery for lung cancer
作者:
荆凤娥
（河南理工大学第一附属医院麻醉手术部,河南　焦作　454000）
Author(s):
JING Feng′e
(Department of Anesthesia Surgery,the First Affiliated Hospital of Henan Polytechnic University,Jiaozuo 454000,Henan Province,China)
关键词:
肺癌根治术; 老年人; 竖脊肌平面阻滞; 罗哌卡因; 右美托咪定
Keywords:
radical resection of pulmonary carcinoma; elderly people; erector spinae plane block; ropivacaine; dexmedetomidine
分类号:
R734.2
DOI:
10.7683/xxyxyxb.2024.03.014
文献标志码:
A
摘要:
目的　探讨超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞在老年胸腔镜肺癌根治术患者中的应用效果。
方法　选择2020年10月至2022年10月在河南理工大学第一附属医院行胸腔镜下肺癌根治术的肺癌患者119例为研究对象。将患者随机分为观察组（n=59）和对照组（n=60），观察组剔除3例，对照组剔除4例，2组最终各纳入56例患者。对照组患者采用超声引导下罗哌卡因竖脊肌平面阻滞麻醉，观察组患者采用超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞麻醉，2组患者麻醉前准备、麻醉诱导和麻醉维持相同，术后均使用静脉自控镇痛泵止痛。记录2组患者入室后（T1）、阻滞成功后（T2）、切皮时（T3）、手术结束（T4）的心率（HR）和平均动脉压（MAP），术后6、12、24、48 h行静息及活动状态下视觉模拟评分法（VAS）评分。比较2组患者术后48 h镇痛药物使用量和镇痛泵按压次数、谵妄和不良反应发生率。
结果　2组患者T2、T3时MAP、HR显著高于T1和T4时（P<0.05）；2组患者T4时与T1时MAP、HR比较差异无统计学意义（P>0.05）；2组患者T2与T3时MAP、HR比较差异无统计学意义（P>0.05）。2组患者T1时MAP、HR比较差异无统计学意义（P>0.05）；T2、T3、T4时，观察组患者的MAP、HR显著低于对照组（P<0.05）。2组患者术后12、24、48 h时静息状态和活动状态下VAS评分均显著低于术后6 h（P<0.05）；2组患者术后24、48 h时静息状态和活动状态下VAS评分均显著低于术后12 h（P<0.05）；2组患者术后48 h时静息状态和活动状态下VAS评分均显著低于术后24 h（P<0.05）。术后6 h，2组患者静息状态和活动状态下VAS评分比较差异无统计学意义（P>0.05）；术后12、24、48 h，观察组患者静息状态和活动状态下VAS评分均显著低于对照组（P<0.05）。观察组患者术后48 h镇痛药物使用量和镇痛泵按压次数显著少于对照组（P<0.05）。对照组和观察组患者术后48 h内总不良反应发生率分别为5.36%（3/56）、8.93%（5/56）；2组患者总不良反应发生率比较差异无统计学意义（χ2=0.135，P>0.05）。对照组和观察组患者术后48 h内谵妄发生率分别为14.29%（8/56）、3.57（2/56）,观察组患者谵妄发生率显著低于对照组（χ2=3.953，P<0.05）。
结论　老年胸腔镜肺癌根治术患者采用超声引导下罗哌卡因复合右美托咪定竖脊肌平面阻滞，可维持围手术期血流动力学稳定、提高镇痛效果，且能减少镇痛药物使用量和镇痛泵按压次数，降低术后谵妄发生率。
Abstract:
Objective　To explore the efficacy of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block (ESPB) in elderly patients undergoing thoracoscopic radical surgery for lung cancer.
Methods　A total of 119 lung cancer patients who underwent thoracoscopic radical resection of pulmonary carcinoma at the First Affiliated Hospital of Henan Polytechnic University from October 2020 to October 2022 were selected and randomly divided into the observation group (n=59) and the control group (n=60),with 3 patients excluded from the observation group and 4 patients excluded from the control group.Finally,56 patients were included in each group.Patients in the control group received ultrasound-guided ESPB with ropivacaine,while patients in the observation group received ultrasound-guided ESPB with both ropivacaine and dexmedetomidine.The pre-anesthesia preparation,anesthesia induction,and anesthesia maintenance were the same for patients in both groups,and patients in both groups used patient-controlled intravenous analgesia to relieve pain after surgery.The heart rate (HR) and mean arterial pressure (MAP) of patients in the two groups after entry (T1),successful block (T2),skin incision (T3),and end of surgery (T4),as well as the visual analogue scale (VAS) scores at rest and activity 6,12,24,and 48 hours after surgery were recorded.The amount of analgesic medication used,the number of analgesia pump presses,and the incidence of delirium and adverse reactions were compared between the two groups 48 hours after surgery.
Results　The MAP and HR of patients in the two groups at T2 and T3 were significantly higher than those at T1 and T4 (P<0.05).However,there was no significant difference in MAP and HR between the two groups at T4 and T1 (P>0.05),and there was also no significant difference in MAP and HR between the two groups at T2 and T3 (P>0.05).The patients in both groups showed no significant difference in MAP and HR at T1 (P>0.05),while at T2,T3,and T4,the MAP and HR in the observation group were significantly lower than those in the control group (P<0.05).The patients in both groups had lower VAS scores at rest and activity 12,24,and 48 hours postope-ratively compared to 6 hours postoperatively (P<0.05).The patients in both groups had lower VAS scores at rest and activity 24 and 48 hours postoperatively compared to 12 hours postoperatively (P<0.05).The patients in both groups had lower VAS scores in both resting and active states 48 hours after surgery compared to 24 hours after surgery (P<0.05).There was no significant difference in VAS scores at both rest and activity 6 hours after surgery between the two groups (P>0.05).At 12,24,and 48 hours after surgery,the patients in the observation group had lower VAS scores in both resting and active states compared to the control group (P<0.05).Compared with the control group,the observation group used fewer analgesic drugs and pressed analgesia pumps less 48 hours after surgery (P<0.05).The incidence of overall adverse reactions within 48 hours after surgery was 5.36% (3/56) and 8.93% (5/56),respectively;there was no significant difference in the incidence of overall adverse reactions between the two groups (χ2=0.135,P>0.05).The incidence of delirium within 48 hours after surgery in the control and observation groups was 14.29% (8/56) and 3.57% (2/56),respectively.The incidence of delirium in the observation group was significantly lower than that in the control group (χ2=3.953,P<0.05).
Conclusion　The use of ropivacaine combined with dexmedetomidine for ultrasound-guided ESPB in elderly patients undergoing thoracoscopic radical surgery for lung cancer can maintain perioperative hemodynamic stability,improve analgesic effect,and reduce the dosage of analgesic drugs,the number of analgesia pump presses,and the incidence of postoperative delirium.

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更新日期/Last Update: 2024-03-05