罗哌卡因、亚甲蓝神经阻滞联合自控镇痛用于胸部恶性肿瘤手术的效果评估

目的：评估罗哌卡因、亚甲蓝神经阻滞联合自控镇痛在胸部恶性肿瘤手术镇痛中的应用价值。方法选取西安交通大学第一附属医院80例择期行胸部手术治疗的恶性肿瘤患者作为研究对象,按麻醉方式不同分为观察组与对照组,每组40例。两组术后均采用地佐辛自控镇痛,观察组术前加用罗哌卡因、亚甲蓝神经阻滞处理,比较两组麻醉前10 min、术后0.5、6、12、24 h不同时间点心率( HR)、血压( BP)的变化情况,苏醒时间,术后1 d地佐辛使用量,术后寒战、呕吐、呼吸抑制等不良反应发生情况。结果麻醉前10 min、术后24 h两组收缩压( SBP )、舒张压(DBP)、HR差异比较无统计学意义(P>0．05),观察组术后0．5、6、12 h SBP和HR低于对照组(P<0．05),SBP高于对照组(P<0．05)；观察组术后苏醒时间短于对照组(P<0．05),术后24 h地佐辛用量少于对照组(P<0．05),按压次数少于对照组(P<0.05)；观察组视觉模拟(VAS)评分,术后即刻、术后12 h均低于对照组(P<0．05)；观察组术后总不良反应发生率为12.5%,低于对照组的45.0%(P<0．05)。结论罗哌卡因、亚甲蓝神经阻滞联合自控镇痛用于胸部恶性肿瘤手术,镇痛效果好,血流动力学稳定,安全性高,临床应用价值高。

Effect Evaluation of Ropivacaine and Methylene Blue Nerve Block Combined with Patient-controlled Intravenous Analgesia in Application of Surgery for Chest Malignant Tumor

Objective To investigate value of Ropivacaine and Methylene Blue nerve block combined with pa-tient-controlled intravenous analgesia ( PCIA) in application of surgical analgesia for patients with chest malignant tumor. Methods A total of 80 malignant tumor patients undergoing elective chest surgery were recruited in this study, and were divided into observation group (n=40) and control group (n=40) according to different anaesthetic methods. All pa-tients were treated with postoperative Dezocine PCIA. Observation group was treated with additional Ropivacaine and Methylene Blue nerve block before surgery. Changes of heart rate ( HR) and blood pressure ( BP) at 10 min before anal-gesia, postoperative 0. 5 h, 6 h, 12 h and 24 h were compared between two groups. Recovery time, Dezocine dosage within postoperative 1 d and incidence rates of postoperative adverse reactions such as chills, vomiting and respiratory de-pression were also observed in two groups. Results At 10 min before analgesia and postoperative 24 h, there were no significant differences in systolic blood pressure ( SBP) , diastolic blood pressure ( DBP) and HR between two groups (P>0. 05). At postoperative 0. 5, 6 and 12 h, SBP and HR levels were lower (P<0. 05), while DBP levels were high-er in observation group than those in control group ( P<0. 05 ) . Postoperative recovery time in observation group was shorter than that in control group, and values of Dezocine dosage in postoperative 24 h and pressing times in observation group were less than those in control group (P<0. 05). In observation group, values of visual analogue scales (VAS) score immediately after surgery and postoperative 12 h were lower than those in control group (P<0. 05). After surgery, total incidence rate of adverse reactions in observation group (12. 5%) was lower than 45. 0% in control group (P<0. 05). Conclusion Ropivacaine and Methylene Blue nerve block combined with patient-controlled intravenous analge-sia ( PCIA) in application of surgical analgesia for patients with chest malignant tumor can achieve good anaesthetic effect with stable hemodynamics and safety.