摘要
目的 研究右美托咪定复合罗哌卡因胸椎旁神经阻滞对冠状动脉搭桥术后心肌再灌注损伤及恢复质量的影响.方法 前瞻性选取2021年3月至2023年2月邯郸市中心医院收治的97例行冠状动脉搭桥术的患者作为研究对象,采用掷硬币法将其分为观察组(n=49)和对照组(n=48).两组患者均在全身麻醉下手术,对照组采用0.5％罗哌卡因20 mL进行胸椎旁神经阻滞,观察组采用0.75 µg/kg右美托咪定+0.5％罗哌卡因20 mL进行胸椎旁神经阻滞.比较两组患者麻醉前、气管插管即刻、切皮后5 min、术毕的平均动脉压(MAP)、心率;记录两组患者的手术时间、术后机械通气时间、拔管时间、苏醒时间、ICU滞留时间及住院时间;比较两组患者手术后12、24 h的疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分,手术前、手术后24 h的肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、天冬氨酸转移酶(AST)水平,以及补救镇痛及并发症发生情况.结果 麻醉前及气管插管即刻,两组MAP、心率比较,差异均无统计学意义(P＞0.05);切皮后5 min及术毕,观察组MAP、心率均低于对照组,差异均有统计学意义(P＜0.05).两组手术时间、术后机械通气时间及苏醒时间比较,差异均无统计学意义(P＞0.05);观察组ICU滞留时间、拔管时间及住院时间分别为(16.58±4.03)h、(5.47±1.23)h、(11.24±2.10)d,均短于对照组[(18.33±4.52)h、(6.02±1.39)h、(12.17 ±2.38)d],差异均有统计学意义(P＜0.05).手术后12、24 h,观察组VAS评分分别为(2.65±0.45)、(2.56±0.59)分,均低于对照组[(2.87±0.53)、(2.92±0.61)分],Ramsay镇静评分分别为(2.15±0.95)、(2.20±0.91)分,均高于对照组(1.63±0.72)、(1.60±0.68)分,差异均有统计学意义(P＜0.05).手术后24 h,两组cTnI、CK-MB及AST水平均较手术前升高,但观察组 cTnI、CK-MB 及 AST 水平分别为(0.96±0.31)ng/mL、(4.91±1.06)ng/mL、(39.08± 7.26)U/L,均低于对照组[(1.16±0.34)ng/mL、(5.61±1.17)ng/mL、(43.14±8.34)U/L],差异均有统计学意义(P＜0.05).两组术后补救镇痛发生率与总并发症发生率比较,差异均无统计学意义(P＞0.05).结论 右美托咪定复合罗哌卡因胸椎旁神经阻滞应用于冠状动脉搭桥术,患者术后恢复更快,镇静效果更好,可显著减轻患者术后疼痛,对患者心肌再灌注损伤更小.
Abstract
Objective To study the effect of dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block on myocardial reperfusion injury and recovery quality after coronary artery bypass grafting.Methods Ninety-seven patients who underwent coronary artery by-pass grafting surgery admitted to Handan Central Hospital from March 2021 to February 2023 were prospectively selected as the study subjects.They were divided into the observation group(n=49)and the control group(n=48)according to coin toss method.Both groups underwent thoracic paravertebral nerve block before induction of anesthesia.The control group received 20 mL of 0.5％ropivacaine for thoracic paravertebral nerve block,while the observation group received 0.75 µg/kg dexmedetomidine+20 mL of 0.5％ropivacaine for thoracic paravertebral nerve block.The mean arterial pressure(MAP)and heart rate of two groups of patients before anesthesia,immediately after tracheal intubation,5 mi-nutes after skin incision,and after surgery were compared.The operation time,postoperative mechanical ventilation time,extubation time,awak-ening time,ICU stay time,and hospitalization time of two groups of patients were recorded.The pain visual analogue scale(VAS)score and Ram-say sedation score of two groups of patients 12 and 24 hours after operation were compared,as well as the levels of cardiac troponin(cTnI),crea-tine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST)before operation and 24 hours after operation,as well as the occurrence of rescue analgesia and complications.Results Before anesthesia and immediately after tracheal intubation,there were no statistically significant differences in MAP and heart rate between the two groups(P＞0.05);after 5 minutes of skin cutting and after operation,the MAP and heart rate of the observation group were lower than those of the control group,and the differences were statistically significant(P＜0.05).There was no sta-tistically significant difference in operation time,postoperative mechanical ventilation time,and recovery time between the two groups(P＞0.05);the ICU stay time,extubation time,and hospitalization time in the observation group were(16.58±4.03)h,(5.47±1.23)h,and(11.24± 2.10)d,respectively,which were shorter than those in the control group[(18.33±4.52)h,(6.02±1.39)h,and(12.17±2.38)d],and the differences were statistically significant(P＜0.05).Twelve and 24 hours after operation,the VAS scores of the observation group were(2.65 ±0.45)and(2.56±0.59)points,respectively,which were lower than those of the control group[(2.87±0.53)and(2.92±0.61)points].The Ramsay sedation scores were(2.15±0.95)and(2.20±0.91)points,respectively,which were higher than those of the control group[(1.63±0.72)and(1.60±0.68)points],and the differences were statistically significant(P＜0.05).Twenty-four hours after operation,the levels of cTnI,CK-MB,and AST in two groups were higher those before operation,however,the levels of cTnI,CK-MB,and AST in the observation group were(0.96±0.31)ng/mL,(4.91±1.06)ng/mL,and(39.08±7.26)U/L,respectively,whih were lower than those in the control group[(1.16±0.34)ng/mL,(5.61±1.17)ng/mL,and(43.14±8.34)U/L],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in the incidence of postoperative salvage analgesia and total complications between the two groups(P＞0.05).Conclusion Dexmedetomidine combined with Ropivacaine thoracic paravertebral nerve block has faster postopera-tive recovery and better sedation effect,which can significantly reduce postoperative pain and cause less damage to myocardial reperfusion.
基金项目
河北省邯郸市科学技术研究与发展计划项目(1823208048ZC)
NETL
NSTL
维普
万方数据