【作者】 沈颖；

【导师】 赵璇；

【作者基本信息】 上海交通大学 ， 麻醉学， 2019， 硕士

【摘要】 目的:观察右美托咪定与地塞米松复合罗哌卡因对胸腔镜直视下肋间神经阻滞效果的影响。方法:选择2018年2月至12月于我院行择期胸腔镜手术的患者,共90例。患者随机分为3组:DEX组(右美托咪定组)、DX组(地塞米松组)、C组(对照组)。患者切皮前均以0.3%罗哌卡因切口浸润,开胸后即行胸腔镜直视下肋间神经阻滞。DEX组予0.3%罗哌卡因+1μg/kg右美托咪定,DX组予0.3%罗哌卡因+5mg地塞米松,C组予0.3%罗哌卡因,共20ml。患者术后均采用病人自控静脉镇痛(PCIA)。观察患者苏醒后(T1)、术后1h(T2)、8h(T3)、12h(T4)、24h(T5)、48h(T6)安静及咳嗽的VAS评分(视觉模拟评分);术后出现明显疼痛的时间;记录T1-T6术后PCIA的次数;术后48小时内镇痛药物的使用情况;记录术后不良反应的发生情况。结果:三组患者术后各时间点安静时VAS评分;T1、T2、T5、T6咳嗽时VAS评分;T1、T2术后PCIA次数;术后48小时内镇痛药物的使用情况;术后不良反应的发生率均无明显统计学差异(P>0.05)。在T3、T4时间点,DEX组及DX组咳嗽时VAS评分显著低于C组,差异有统计学意义(P<0.05)。在T3-T6时间点,DEX组及DX组术后PCIA次数显著低于C组,差异有统计学意义(P<0.05)。患者术后出现明显疼痛时间方面,DEX组与DX组明显迟于C组,差异有统计学意义(P<0.05)。结论:罗哌卡因中加入1μg/kg的右美托咪定和5mg地塞米松均可延长胸腔镜直视下肋间神经阻滞的时间及改善其镇痛效果。更多还原

【Abstract】 Objective:To observe the effect of dexmedetomidine and dexamethasone combined with ropivacaine on postoperative analgesia after intercostal nerve block under thoracoscopy.Methods:Ninety patients who underwent elective thoracoscopic surgery in our hospital from February to December in 2018 were selected.The patients were randomly divided into three groups: group DEX(group dexmedetomidine),group DX(group dexamethasone),and group C(group control).All patients were infiltrated with 0.3% ropivacaine incision before skin incision.Intercostal nerve block under thoracoscopy was performed immediately after thoracotomy.Intercostal nerves were block under thoracoscopy with 0.3% ropivacaine and 1μg/kg dexmedetomidine in group DEX,0.3%ropivacaine and 5mg dexamethasone in group DX,and 0.3% ropivacaine in group C.The volume of local anesthetics is 20 ml.All patients were treated with patient controlled intravenous analgesia(PCIA).The VAS scores were observed after awakening(T1),1 h(T2),8 h(T3),12 h(T4),24 h(T5),48 h(T6)after operation when patients were quiet or coughing(active);the time of obvious pain after operation;the times of PCIA at T1-T6;use of analgesic drugs used within 48 hours after operation; and the occurrence of adverse reactions after operation.Results:There were no significant differences in postoperative resting VAS score,postoperative coughing VAS score at T1,T2,T5,T6;PCIA frequency at T1,T2;use of analgesics within 48 hours and incidence of adverse reactions among the three groups(P > 0.05).Postoperative coughing VAS score in group DEX and DX were significantly lower than those in group C at T3 and T4(P < 0.05).The number of PCIA in group DEX and group DX was significantly lower than that in group C at T3—T6 (P < 0.05).In terms of the time of obvious pain after operation,group DEX and group DX was significantly later than group C(P < 0.05).Conclusions: When intercostal nerve block under thoracoscopy was performed in patients undergoing thoracic surgery,adding 1 μg/kg dexmedetomidine and 5 mg dexamethasone to ropivacaine could prolong the time of intercostal nerve block and enhance the effect of postoperative analgesia.更多还原