右美托咪定复合罗哌卡因对乳腺手术患者行胸椎旁神经阻滞麻醉效果的影响

目的:观察右美托咪定复合罗哌卡因行胸椎旁神经阻滞麻醉对乳腺包块切除术的临床效果。方法:选择择期行乳腺包块手术患者60例,用随机双盲法分为对照组(C组,n=30)及实验组(D组,n=30),每组各30例,实验组给予(右美托咪定1μg·kg^-1+0.375%罗哌卡因20 ml)行胸椎旁神经阻滞,对照组给予(0.375%罗哌卡因20 ml+同实验组右美托咪定容积0.9%氯化钠)行胸椎旁神经阻滞。分别记录患者入室时(T₀)、胸椎旁神经阻滞后15 min(T₁)、手术开始时(T₂)、肿块切除时(T₃)、手术结束时(T₄)的HR(心率)、MAP(平均动脉压)、SpPO₂(血氧饱和度)和Ramsay镇静评分。观察2组感觉神经阻滞起效时间、感觉神经阻滞恢复时间以及术后不良反应发生情况。结果:实验组与对照组比较,在T₁~T₄时MAP降低、HR减慢,差异有统计学意义(P<0.05)。实验组在T₁~T₄时的Ramsay评分高于对照组,差异有统计学意义(P<0.05)。2组在T₀时MAP、HR及各时点SpO₂比较,差异无统计学意义(P>0.05)。实验组感觉神经阻滞恢复时间比对照组延长,差异有统计学意义(P<0.01)。实验组术后不良反应发生率与对照组比较,差异无统计意义(P>0.05)。结论:右美托咪定复合罗哌卡因用于乳腺乳腺包块切除术,可明显增强胸椎旁神经阻滞麻醉效果,保持血流动力学的稳定、缩短感觉神经阻滞起效时间、延长感觉神经阻滞恢复时间,利于术后镇痛。

Effects of dexmedetomidine in combination with ropivacaine on anesthetic effects of thoracic paravertebral block in patients undergoing breast surgery

OBJECTIVE To observe clinical effects of thoracic paravertebral nerve block via anesthesia in breast mass excision by using dexmedetomidine in combination with ropivacaine. METHODS Sixty patients undergoing elective breast surgery were randomly divided into two groups by double blind method:control group (group C, n=30) and test group (group D, n=30). Dexmedetomidine 1μg·kg^-1+20 ml of 0.375% ropivacaine were administrated to patients in group D to perform thoracic paravertebral nerve block, 20 ml of 0.375% ropivacaine+0.9% NaCl of equal volume were given to patients in group C. Heart rate (HR), mean arterial pressure (MAP), SpO₂ and Ramsay sedation score in each group were recorded at five time points, namely the time entering operating room (T₀), 15 min after thoracic paravertebral block (T₁), beginning of operation (T₂), lumpectomy (T₃) and end of operation (T₄). Onset time and recovery time of sensory nerve block and postoperative adverse reactions were observed in each group. RESULTS MAP and HR in group D at T₁ and T₄ decreased significantly than those in group C (P<0.05). Ramsay sedation scores in group D at T₁ and T₄ were significantly higher than those in group C (P<0.05). MAP and HR at T₀ as well as SpO₂ at all time points in both groups showed no statistically significant difference (P>0.05). Recovery time of sensory nerve block in group D was significantly longer than that in group C (P<0.01). There was no statistically significant difference in incidence of adverse reactions between group D and C (P>0.05). CONCLUSION Dexmedetomidine in combination with ropivacaine can greatly enhance anesthetic effects of thoracic paravertebral nerve block in breast mass excision, maintain hemodynamic stability, shorten onset time of sensory nerve block and prolong recovery time of sensory nerve block, thus improve postoperative analgesia.