摘要
目的探讨右美托咪定复合胸椎旁神经阻滞对开胸术后疼痛及认知功能的影响。方法择期行开胸食管癌根治术老年男性患者60例,采用随机数字表法将其分为单纯全身麻醉组(C组)、罗哌卡因组(R组)及右美托咪定+罗哌卡因组(DR组)。DR组在全身麻醉诱导前10min内予以静脉输注右美托咪定1μg·kg^(-1)。R组和DR组于全身麻醉诱导前行胸椎旁神经阻滞(T_4—T_9),R组在椎旁间隙内注入0.5%罗哌卡因30 mL,DR组则注入0.5%罗哌卡因+0.5μg·kg^(-1)右美托咪定混合液30mL。3组术后均连接静脉镇痛泵。记录3组患者输注右美托咪定前(T_0)、麻醉诱导前(T_1)、手术开始后2h(T_2)、术毕(T_3)以及术后1、6、12、24、36、48h(T_4-9)时的HR、MAP;记录T_4-9静息和咳嗽疼痛VAS评分;记录术中全身麻醉药物用量及术后48h内PCA自控给药次数;于T_0、T_2、T_3、T_6以及T_7时抽取静脉血采用酶联免疫(ELISA)法测定血清IL-6、TNF-α及s100β蛋白水平;于T_0及T_7、T_9、术后7d(T_10)进行MMSE评分。结果与T_0比较,DR组在T_1时MAP下降及HR减慢,C组在T_4-6时HR增快,在T_2、T_3、T_6及T_7时血清IL-6、TNF-α及s100β蛋白水平升高,在T_7、T_9时MMSE评分下降,R组及DR组在T_2、T_3时血清IL-6、TNF-α升高(P<0.05)。与R组比较,C组在T_4-6时疼痛VAS评分升高,术中丙泊酚、瑞芬太尼用量以及术后PCA自控给药次数增多,血清IL-6、TNF-α及s100β蛋白水平在T_2、T_3、T_6及T_7时升高;DR组在T_7-9时静息和咳嗽疼痛VAS评分下降,术中丙泊酚、瑞芬太尼用量以及术后PCA自控给药次数减少,T_6及T_7时血清IL-6、TNF-α下降,T_7及T_9时MMSE评分升高(P<0.05)。结论静脉及局部应用右美托咪定复合胸椎旁神经阻滞可减轻开胸术后疼痛应激反应,并减少术后早期认知功能改变。
Objective To investigate the effect of dexmedetomidine combined with thoracic paravertebral block(TPVB)on pain and cognitive function after thoracotomy.Methods Sixty male geriatric patients scheduled for radical surgery for esophageal carcinoma were randomly divided into three groups:general anesthesia group(group C),ropivacaine group(group R)and dexmedetomidine+ropivacaine group(group DR).The group DR was given intravenous infusion of 1μg·kg-1 dexmedetomidine within 10 minutes before general anesthesia induction.Both group R and group DR received TPVB(T 4-T 9)before general anesthesia induction.In addition,group R was given paravertebral injection of 30 mL 0.5%ropivacaine,and group DR was given 30 mL mixture of 0.5%ropivacaine and 0.5μg·kg-1 dexmedetomidine.All the three groups received postoperative patient-controlled intravenous analgesia(PCA).Heart rate(HR)and mean arterial pressure(MAP)were recorded before dexmedetomidine administration(T 0),before analgesia induction(T 1),2 hours after incision(T 2),at the end of operation(T 3),and 1,6,12,24,36 and 48 hours after operation(T 4-9).The resting and coughing VAS scores were measured at T 4-9.The amount of anesthetics was recorded during operation and PCA pressing frequency was determined within 48 hours after operation.Venous blood samples were collected at T 0,T 2,T 3,T 6 and T 7,and serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and s100βlevels were detected by ELISA.The mini-mental state examination(MMSE)score was measured at T 0,T 7,T 9 and T 10.Results Compared with T 0,HR and MAP at T 1 were decreased in group DR,HR at T 4-6 and serum IL-6,TNF-αand s100βlevels at T 2,T 3,T 6 and T 7 were increased but MMSE scores at T 7 and T 9 were reduced in group C,and serum IL-6 and TNF-αlevels at T 2 and T 3 were elevated in both group C and group DR(P<0.05).Compared with group R,VAS scores at T 4-6,serum IL-6,TNF-αand s100βlevels at T 2,T 3,T 6 and T 7,the amount of propofol and remifentanil and postoperative PCA pressing frequency were increas
作者
肖凡
罗振中
周斌
华福洲
黄丹
XIAO Fan;LUO Zhen-zhong;ZHOU Bin;HUA Fu-zhou;HUANG Dan(Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《南昌大学学报（医学版）》
CAS
2018年第1期60-64,共5页
Journal of Nanchang University：Medical Sciences
关键词
右美托咪定
胸椎旁神经阻滞
开胸术
术后疼痛
术后认知功能
dexmedetomidine
thoracic paravertebral block
thoracotomy
postoperative pain
postoperative cognitive function
