摘要
目的探讨胸膜腔内注射罗哌卡因用于胸腔镜辅助小切口手术(VAMT)术后镇痛的可行性。方法选择我院择期在全麻下行VAMT患者60例,ASAⅠ或Ⅱ级,随机均分为研究组和对照组。两组麻醉诱导和维持方法相同,当胸内操作完毕清理胸腔后,研究组:0.75%罗哌卡因2ml稀释至5ml,胸腔闭式引流切口处局部浸润,放置胸腔闭式引流管后用带喷雾头的注射器将0.75%罗哌卡因20ml均匀喷洒于术侧胸膜、肺表面及周围组织,关胸后将剩余0.75%罗哌卡因均匀地喷洒于切口表面,逐层浸润缝合。对照组不做任何处理。观察记录术后6、24、48h时VAS评分、Ram-say镇静评分、哌替啶用药例次,术前、术后6h血浆皮质醇浓度及并发症。结果术后6、24、48h时VAS评分对照组明显高于研究组(P<0.01),两组Ramsay镇静评分差异无统计学意义,术后6、24h哌替啶使用例次对照组明显高于研究组(P<0.01),术后6h对照组血浆皮质醇浓度明显高于术前和研究组(P<0.01),两组并发症差异无统计学意义。结论胸膜腔内注射足量罗哌卡因用于VAMT术后镇痛安全有效。
Objective To evaluate the efficiency in pain control of local infiltration of ropivacaine after video-assisted mini thoraeotomy（VAMT）. Methods Sixty ASA Ⅰ or Ⅱ patients received VAMT under general anesthesia, were randomly assigned to two groups （n= 30 each）： the study group and the control group. The anesthesia were induced and maintained with the same methods in both groups. After cleaning the chest when the intrathoracic operation was done, for the group study, 0.7% ropivacaine 30 ml was taken for future use. Before the closed thoracic drainage tube was placed, 2 rnl of 0.75% ropivacaine was diluted to 5 ml and injected locally. Another 20 ml of 0.75% ropivaeaine was evenly sprayed on the operative side pleural, lung surface, surrounding tissues. The remaining 0.75% ropivacaine was sprayed around the surface of cut, after the chest was closed. The control group received no treatment. VAS scores, Ramsay scores, cases of pethidine application were evaluated at the points of 6, 24 and 48 h after surgery. The incidence of complication was observed, plasma cortisol concentration before and 6 h after surgery were managed. Results The VAS scores of the control group were obviously higher than those of the study group at the time points of 6, 24, 48 h after surgery（P〈0.01）, There were no significant differences of the Ramsay score between the two groups. The number of the cases with pethidine application of the control group were obviously higher than those of the study group at the time points of 6, 24 h after surgery （P〈0.01）. The plasma cortisol concentration of the control group at the point of 6 h after operation were obviously higher than those of the study group and before surgery（P〈0.01）, but the plasma cortisol concentration of the test group had no significant differences. The incidence of complication of two groups had no differences. Conclusion Local infiltration of ropivacaine in pleural cavity could safely and effectively control the pain after VAMT.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第3期235-237,共3页
Journal of Clinical Anesthesiology
关键词
胸腔镜辅助小切口手术
罗哌卡因
胸膜腔
术后镇痛
全身麻醉
Video-assisted mini l：horacotomy
Ropivacaine
Pleural cavity
Postoperative analgesia
General anesthesia
