小剂量右美托咪定胸椎旁神经阻滞在胸科手术中镇痛效果.doc

小剂量右美托咪定胸椎旁神经阻滞在胸科手术中的镇痛效果 　　[摘要] 目的 观察小剂量右美托咪定联合罗哌卡因胸椎旁间隙神经阻滞用于胸科手术患者术后镇痛的效果，以及对患者应激反应的影响。 方法 选择2015年1～12月保定市第二中心医院胸外科拟行胸腔镜辅助胸科手术的患者60例，按随机数字法分为DR组和R组，每组30例。所有患者均采用全身麻醉并于麻醉前做患侧连续胸椎旁神经阻滞置管镇痛，DR组神经阻滞药物应用右美托咪定联合罗哌卡因，R组神经阻滞药物单纯应用罗哌卡因。观察并比较两组患者术后6、12、24、48 h的VAS、Ramsay评分以及平均动脉压（MAP）、心率（HR）的变化；术后48 h内镇痛泵自控给药次数、术后额外追加曲马多用量以及术后24、48 h时的血清皮质醇浓度。 结果 DR组术后各时间点的VAS评分、术后48 h内镇痛泵自控给药次数、曲马多用量少于R组，血清皮质醇浓度低于R组，MAP、HR也低于R组，差异均有统计学意义（P 0.05）。 结论 小剂量右美托咪定联合低浓度罗哌卡因胸椎旁间隙神经阻滞术后镇痛，能降低胸科手术患者的应激水平，提供合适的镇痛镇静效果，维持稳定的血流动力学水平 [关键词] 右美托咪定；胸椎旁神经阻滞；术后镇痛；血清皮质醇浓度 [中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2016）09（a）-0096-04 [Abstract] Objective To observe the effect of Dexmedetomidine combined with Ropivacaine for thoracic paravertebral nerve block on postoperative analgesia in patients undergoing thoracic surgery and its influence on the stress response in patients. Methods From January to December 2015， 60 cases of patients with video-assisted thoracic surgery in the Second Central Hospital of Baoding were selected. The cases were randomly divided into two groups with 30 cases in each group. All the cases adopted general anesthesia and preoperative continuous thoracic nerve block analgesia. In DR group， Dexmedetomidine combined with Ropivacai was applied， R group were treated with Ropivacaine. VAS， Ramsay score of postoperative 6， 12， 24， 48 h and the changes in MAP， HR， postoperative analgesia pump control delivery times within 48 h， postoperative extra dosage of tramadol and postoperative serum cortisol concentration at the time of 24， 48 h of the two groups were observed and compared. Results Postoperative VAS score， dosage of Tramadol and postoperative analgesia pump control delivery times within 48 h of DR group were less than R group， the serum cortisol concentration was lower than R group， the changes of MAP， HR was lower than that of R group. The differences were statistically significant （P 0.05）. Conclusion Thoracic paravertebral nerve block using low dose of Dexmedetomidine combi