右美托咪定静脉给药对罗哌卡因椎旁阻滞镇痛效果的影响

目的 观察右美托咪定（DEX）经静脉给药对罗哌卡因椎旁神经阻滞镇痛效果的影响。方法 选取2017年5月~2019年1月我院择期行胸腔镜手术患者90例，随机分为对照组、DEXIV组和DEXP组，各30例。对照组不使用DEX，DEXIV组为DEX静脉给药，DEXP组为DEX神经周围给药，比较三组患者进入复苏室即刻（PACU）、椎旁神经阻滞后6、12、24 h的VAS疼痛评分，病人自控静脉镇痛（PCIA）术后首次按压时间、累计按压次数、镇痛药物需求及不良反应发生情况。结果 三组PACU时刻VAS评分比较，差异无统计学差异（P＞0.05）；对照组术后6、12 h VAS评分高于DEXIV组和DEXP组，差异有统计学意义（P＜0.05）；DEXIV组与DEXP组术后6、12 h VAS评分比较，差异无统计学意义（P＞0.05）；三组术后24 h VAS评分比较，差异无统计学意义（P＞0.05）。对照组PCIA首次自控按压时间早于DEXIV组与DEXP组，且累计按压次数高于DEXIV组与DEXP组，差异有统计学意义（P＜0.05）；DEXIV组与DEXP组首次按压时间、累计按压次数比较，差异无统计学意义（P＞0.05）。三组额外镇痛药物需求比较，差异无统计学意义（P＞0.05）；DEXIV组仅有1例患者发生心动过缓，三组不良反应比较，差异无统计学意义（P＞0.05）。结论 无论是经静脉还是神经周围给药DEX均能延长罗哌卡因单次胸椎旁神经阻滞的镇痛时间，减少镇痛药物消耗和不良反应发生几率。

Effect of Intravenous Administration of Dexmedetomidine on Analgesic Effect of Ropivacaine Paraspinal Block

Objective To observe the effect of intravenous administration of dexmedetomidine (DEX) on the analgesic effect of ropivacaine paraspinal nerve block.Methods 90 patients undergoing thoracoscopic surgery in our hospital from May 2017 to January 2019 were randomly divided into control group, DEXIV group and DEXP group, 30 cases each. DEX was not used in the control group, DEX was administered in the DEXIV group, and DEX was administered in the DEXP group. VAS pain was observed in the three groups of patients immediately after entering the resuscitation chamber (PACU) and paravertebral nerve block lag of 6, 12, and 24 h. Score, patient-controlled intravenous analgesia (PCIA), first press time, cumulative compressions, analgesic drug requirements, and adverse events.Results There were no significant differences in VAS scores between the three groups of PACU (P>0.05). The VAS scores of the control group at 6 and 12 h after operation were higher than those of DEXIV and DEXP,the difference was statistically significant (P<0.05); There was no significant difference in VAS scores between the DEXIV group and the DEXP group at 6 and 12 h after operation (P>0.05). There was no significant difference in VAS scores between the three groups after 24 h (P>0.05).The first self-controlled compression time of PCIA in the control group was earlier than that in the DEXIV group and the DEXP group, and the cumulative compression times were higher than those in the DEXIV group and the DEXP group,the difference was statistically significant (P<0.05). There was no significant difference in the first compression time and cumulative compression times between DEXIV group and DEXP group (P>0.05). There was no significant difference in the demand of the three groups of additional analgesic drugs (P>0.05). Only one patient in the DEXIV group had bradycardia. There were no significant differences between the three groups (P>0.05).Conclusion Both intravenous and peri-injection of DEX can prolong the analgesic time of ropivacaine single thoracic paravertebral nerve block and reduce the incidence of analgesic drug consumption and adverse reactions.