摘要
目的探讨舒芬太尼复合罗哌卡因竖脊肌阻滞用于肺癌患者术后镇痛的效果及安全性。方法 60例择期行开胸肺癌手术患者,采用随机数字法随机分为观察组和对照组,每组30例。所有患者麻醉诱导前行超声引导下竖脊肌阻滞。所有患者取侧卧位,采用平面外法进针,触及T5横突骨质后,对照组注入0.25%罗哌卡因30ml。实验组注入0.25%罗哌卡因30ml,其中混合舒芬太尼10μg。注药完成后30min测定阻滞平面。记录两组患者年龄,性别,体重指数,ASA分级,手术时间等。采用疼痛视觉评分(Visual Analogue Scale,VAS)评估患者术后1h,6h,12h,24h,48h时静息状态和咳嗽状态下的疼痛评分;记录患者术中瑞芬太尼用量,镇痛泵按压次数及氟比洛芬酯的追加例数;记录患者入手术室后(T1),竖脊肌阻滞完成后5min(T2),竖脊肌阻滞完成后20min(T3),切皮时(T4),苏醒拔管后(T5)时的平均动脉压(MAP)和心率(HR);记录头晕、恶心呕吐、皮肤瘙痒、气胸有无、呼吸抑制与否及有无全脊麻、低血压等不良事件。结果与对照组比较,观察组患者在术后24h及48h时静息状态下疼痛评分显著降低(P<0.05);在术后12h,24h及48h,观察组患者咳嗽下疼痛评分显著降低(P<0.05)。其余时点两组疼痛评分均无显著性差异(P>0.05)。同时观察组患者瑞芬太尼用量,镇痛泵按压次数均显著少于对照组(P<0.05);两组患者不良事件及基本信息比较无差异(P>0.05)。结论 10μg舒芬太尼复合0.25%罗哌卡因30ml竖脊肌阻滞能够有效发挥术后镇痛作用,作用时间延长,而且对患者无明显不良反应,是一个较好的选择。
Objective To evaluate the efficacy and safety of sufentanil combined with ropivacaine for postoperative analgesia in patients with lung cancer.Methods 60 patients who underwent thoracoscopic lung cancer surgery were randomly divided into observation group and control group,with 30 cases in each group.All patients underwent sonography-guided vertical spinal block prior to anesthesia induction.All patients were placed in lateral position.After T5 transverse process was touched,0.25%ropivacaine 30 ml was injected in the control group,while 0.25% ropivacaine30 ml,including 10μg of sufentanil were injected in the experimental group.The blocking plane was determined 30 min after injection.Age,sex,body mass index,ASA classification and operation time were recorded in the two groups.Visual pain score(VAS)was used to evaluate the pain scores in resting state and cough state at 1 h,6 h,12 h,24 hand 48 h postoperatively.The intraoperative dosage of remifentanil,the number of analgesic pump compressions and the number of additional cases of flurbiprofen ester were recorded.The average arterial pressure(MAP)and heart rate(HR)of the patients were recorded after entering the operating room(T1),5 min after the completion of vertical spinal block(T2),20 min after the completion of vertical spinal block(T3),at the time of skin resection(T4),and at the time of resuscitation and extubation(T5).Adverse events were recorded,including dizziness,nausea,vomiting,itchy skin,pneumothorax,respiratory depression,and the presence or absence of spinal anesthesia and hypotension.Results Compared with the control group,the pain score in the observation group was significantly reduced at 24 hand 48 hpostoperatively(P<0.05).At 12 h,24 hand 48 hpostoperatively,pain scores under cough were significantly reduced in the observation group(P<0.05).There was no significant difference in pain scores between the two groups at other time points(P>0.05).At the same time,the dosage of remifentanil,the number of analgesic pump compressions and the number of c
作者
赵晓楠
关雷
刘鹏飞
王邵恒
刘文涛
陈立芳
冯枫
汪润
ZHAO Xiao-nan;GUAN Lei;LIU Peng-fei(Department of Anesthesiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中国实验诊断学》
2020年第2期234-238,共5页
Chinese Journal of Laboratory Diagnosis
关键词
舒芬太尼
罗哌卡因
胸腔镜
竖脊肌阻滞
镇痛效果
sufentanil
Ropivacaine
Thoracoscope
Vertical spinal block
Analgesic effect
