医学临床研究
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医学临床研究  2019, Vol. 36 Issue (9): 1718-1720    DOI: 10.3969/j.issn.1671-7171.2019.09.018
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右美托咪定联合罗哌卡因胸椎旁神经阻滞对食管癌切除患者的效果
陈晓红
四川省遂宁市中心医院手麻二部,四川 遂宁 629000
Effect of Dexmedetomidine Combined with Ropivacaine on Thoracic Paravertebral Nerve Block in Patients with Esophageal Cancer Resection
CHEN Xiao-hong
Suining City Central Hospital, Sichuan Province 629000
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摘要 目的】探讨右美托咪定(Dex)联合罗哌卡因胸椎旁神经阻滞(TPVB)对食管癌切除患者镇痛效果及氧化应激、炎性反应的影响。【方法】行食管癌根治开胸手术患者60例,随机分为两组,每组各30例,观察组给予Dex联合罗哌卡因,对照组给予罗哌卡因行TPVB。记录两组患者给药前(T0)、给药后30 min(T1)、气管插管即刻(T2)、肿块切除(T3)及术毕(T4)不同时点脑电双频谱指数(BIS)、心率(HR)、平均动脉压(MAP)。观察并比较术后48 h内不同时间点自控镇痛(PCA)自控给药次数及患者疼痛视觉模拟评分法(VAS)评分;记录术前及术后3 h、24 h、48 h患者血清皮质醇、C反应蛋白、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)浓度。【结果】与术前相比,两组的BIS在T1~T4时降低(P<0.05),而两组患者不同时点的HR、MAP变化差异无显著性(P>0.05);观察组各时间点的VAS评分明显低于对照组(P<0.05),术后48 h内PCA 自控给药次数明显低于对照组(P<0.05)。两组术前皮质醇、C 反应蛋白、TNF-α和IL-6 浓度比较差异无显著性(P>0.05);两组术后3 h、24 h、48 h时点上述各指标浓度均明显增加(均P<0.05),但观察组增加幅度明显低于对照组(P<0.05)。【结论】食管癌手术患者采用Dex联合罗哌卡因TPVB能显著延长阻滞时间,减轻患者术后疼痛及氧化应激和炎症反应,值得临床应用。
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陈晓红
关键词 食管肿瘤/外科学神经传导阻滞/方法麻醉右美托咪定    
Abstract:【Objective】To investigate the effects of dexmedetomidine (Dex) combined with ropivacaine on analgesia, stress reaction and inflammatory reaction through the application of thoracic paravertebral nerve block (TPVB) in patients with esophageal cancer radical resection. 【Methods】A total of 60 patients with esophageal cancer underwent thoracotomy were randomly divided into two groups, with 30 cases in each group. The observation group was given Dex combined with ropivacaine and the control group was given ropivacaine alone for application of TPVB. The MAP, HR and BIS (bispectral index) were recorded before injection (T0), 30min after injection (T1), immediately after endotracheal intubation (T2), excision of tumor (T3) and at the end of operation (T4). The VAS (visual analogue scale) scores and postoperative analgesia pump control delivery times at different time points within 48 h after surgery were compared in the two groups. The concentrations of cortisol, c-reactive protein, TNF- α and IL-6 were measured before surgery and 3h, 24h and 48h after operation. 【Results】There was no difference in MAP and HR at different time points in the two groups (P>0.05). Compared to pre-operation, the BIS of the two groups decreased at T1~T4 (P<0.05).The VAS scores at different time points were lower in observation group than in the control group (P<0.05). Also, the postoperative analgesia pump control delivery times within 48 h after surgery were lower than those in the control group (P<0.05). There were no significant differences in preoperative concentrations of cortisol, c-reactive protein , TNF- α and IL-6 between the two groups (P>0.05). The concentrations of the above indexes were significantly increased at 3 h, 24 h and 48 h after surgery. However, the increase of the observation group was lower than that of the control group (P<0.05). 【Conclusion】Dex combined with ropivacaine in TPVB can significantly prolong the effect of nerve block, improve postoperative analgesia, and decrease the stress reaction and inflammatory reaction in the patients with esophageal cancer undergoing thoracic surgery.
Key wordsEsophageal Neoplasms/SU    Nerve Block/ME    Anesthesia    Dexmedetomidine
收稿日期: 2018-04-28     
PACS:  R735.1  
引用本文:   
陈晓红. 右美托咪定联合罗哌卡因胸椎旁神经阻滞对食管癌切除患者的效果[J]. 医学临床研究, 2019, 36(9): 1718-1720.
CHEN Xiao-hong. Effect of Dexmedetomidine Combined with Ropivacaine on Thoracic Paravertebral Nerve Block in Patients with Esophageal Cancer Resection. JOURNAL OF CLINICAL RESEARCH, 2019, 36(9): 1718-1720.
链接本文:  
http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2019.09.018     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2019/V36/I9/1718
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