超声引导下右美托咪定联合不同神经阻滞在胸腔镜术后相关导管性疼痛的镇痛效果比较

Comparison of Analgesic Effects of Dexmedetomidine Combined with Different Nerve Blocks under Ultrasound Guidance on Catheter-Related Pain after Thoracoscopic Surgery

摘要: 目的：本研究旨在比较右美托咪定联合罗哌卡因超声引导下行椎旁神经阻滞与肋间神经阻滞在胸腔镜术后胸腔闭式引流导管相关性的患者疼痛的控制效果，以期为胸腔镜术后的患者提供更优效、副作用少的镇痛方案。方法：选取60例行胸腔镜手术患者分别行两种神经阻滞进行术后镇痛。根据不同入路，采用随机数字法将其分为两组，每组30例：胸椎旁组(A组)：接受标准的超声引导下右美托咪定1 μg/kg联合0.5%罗哌卡因行胸椎旁神经阻滞治疗，根据患者实际情况调整在胸腔镜开口处所相应的胸椎椎旁神经给予5 ml阻滞药后进行全身麻醉。肋间组(B组)：接受标准的超声引导下右美托咪定1 μg/kg联合0.5%罗哌卡因肋间经阻滞治疗，每处肋间神经给予5 ml治疗量后进行全身麻醉。分析A、B两组的患者基本情况、引流管疼痛的评估、术后24 h疼痛发生率、术后Ramsay镇静评分及镇痛泵使用情况、术后72小时相关性肺炎。结果：A组和B组患者一般资料及术后72小时相关性肺炎方面差异均无统计学意义(P > 0.05)。两组术后24 h引流管导致疼痛的评分及镇静评分、镇痛泵情况及疼痛发生率(P < 0.05)，差异具有统计学意义。结论：超声引导下右美托咪定联合罗哌卡因行椎旁神经阻滞比肋间神经阻滞能够更有效的减轻患者术后引流管疼痛。

Abstract: Aim: The purpose of this study is to compare the pain control effects of paravertebral nerve block and intercostal nerve block guided by dexmedetomidine combined with ropivacaine in patients with closed thoracic drainage catheter after thoracoscopic surgery, so as to provide better analgesic scheme with fewer side effects for patients after thoracoscopic surgery. Methods: 60 patients undergoing thoracoscopic surgery were selected to receive two kinds of nerve block for postoperative analgesia. According to different approaches, they were randomly divided into two groups, with 30 cases in each group: Paravertebral group (Group A): Patients were treated with standard ultrasound-guided dexmedetomidine 1 μg/kg combined with 0.5% ropivacaine for paraplegic nerve block, and then were given general anesthesia after adjusting the corresponding paravertebral nerve at the opening of thoracoscope according to the actual situation of patients. Intercostal group (Group B): The intercostal nerve was blocked by dexmedetomidine 1 μg/kg combined with 0.5% ropivacaine under the guidance of standard ultrasound, and 5 ml was given to each intercostal nerve for general anesthesia. The basic situation of patients in Group A and Group B, the evaluation of drainage tube pain, the incidence of pain in 24 hours after operation, Ramsay sedation score and the use of analgesic pump after operation, and the associated pneumonia in 72 hours after operation were analyzed. Results: There was no significant difference between Group A and Group B in general information and 72-hour postoperative pneumonia (P > 0.05). There were significant differences in the scores of pain caused by drainage tube, sedation score, analgesic pump and pain incidence between the two groups (P < 0.05). Conclusion: Paravertebral nerve block with dexmedetomidine combined with ropivacaine under ultrasound guidance is more effective than intercostal nerve block in relieving postoperative drainage tube pain.