| 摘要: |
| 目的探讨罗哌卡因联合吗啡行胸段硬膜外麻醉在非插管胸腔镜肺叶楔形切除手术中的最佳有效浓度。方法选择60例接受非插管胸腔镜手术的患者，在T6~T7行硬膜外穿刺置管，给予2mg吗啡，按随机数字表法分为0.3%罗哌卡因（A组）、0.2%罗哌卡因（B组）、0.1%罗哌卡因（C组），每组20例。3组患者术中均在瑞芬太尼和右美托咪啶联合注射下经面罩行自主呼吸，观察3组患者给予罗哌卡因前5min（T0）、给予罗哌卡因后15min（T1）、人工气胸时（T2）、人工气胸后30min（T3）、手术结束（T4）5个时点血流动力学变化，记录术后1、4、8、24h患者静息和咳嗽时视觉模拟评分（VAS），记录术中呛咳、低氧血症和高碳酸血症和术后恶心、呕吐等并发症发生情况。结果A组T1、T2、T4时平均动脉压明显低于B组和C组（均P＜0.05），B组T3和T4心率明显低于A组和C组（P＜0.05），C组T2和T3呼吸频率较A组和B组显著增快（P＜0.05）；A组和B组术后1h的咳嗽VAS评分以及8h和24h的静息和咳嗽VAS低于C组（均P＜0.05）；A组术后恶心、呕吐发生率高于B和C组（P＜0.05），且C组低氧和高碳酸血症发生率及呛咳次数多于A组和B组（P＜0.05）。结论罗哌卡因联合2mg吗啡用于非插管胸腔镜手术硬膜外麻醉时，0.2%是最佳有效浓度，镇痛效果好，并发症最少。 |
| 关键词: 罗哌卡因 硬膜外麻醉 胸腔镜手术 楔形切除 |
| DOI：10.12056/j.issn.1006-2785.2017.39.5.2016-766 |
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| Efficacy of ropivacaine with different concentrations on non-intubated thoracoscopic wedge resection under thoracic epidural anesthesia |
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ZHU Binbin, SUN Jian, CHEN Fugui, ZHANG Rui, GUI Yu
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the Affiliated Hospital,College of Medicine, Ningbo University
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| Abstract: |
| Objective To investigate optimal concentration of ropivacaine combined with morphine in non-intubated thoracoscopic wedge resection surgery under thoracic epidural anesthesia. Methods Sixty patients undergoing non-intubated thoracoscopic wedge resection were randomized into three groups: patients received 0.3% (group A), 0.2% (group B) or 0.1% (group C) ropivacaine plus morphine 2mg in epidural space, respectively. Three groups were all sedated with continuous infusion of remifentanil and dexmedetomidine, and patients had spontaneous breathing with oxygen supplement via face mask. Vital signs and hemodynamic changes were monitored and adverse events including coughing, hypoxemia, hypercapnia, nausea and vomiting were documented at 5min before administration of ropivacaine (T0), 5min after ropivacaine (T1), during artificial pneumothorax (T2), 30min after pneumothorax (T3) and by the end of operation (T4), the visual analogue scale (VAS) at1h, 4h, 8h, 24h after surgery was evaluated. Results The mean arterial pressure in group A at T1, T2 and T4 were significantly lower than those in groups B and C (P＜0.05), the heart rate at T3 and T4 in group B was lower than that in groups A and C (P＜0.05), the respiratory rate at T2 and T3 in group C was higher than that in groups A and B; the incidence of nausea and vomiting in group A
was higher than that of other two groups; and the incidence of coughing in group C was more frequent than that in groups A and B(P＜0.05). There were more cases in group C with hypoxia and hypercapnia as well as coughing during the operation compared with other two groups (P＜0.05). The VAS during coughing at 1h after operation and VAS during rest and coughing at 8h, 24h in
group A and group B were significant lower than those in group C (P＜0.05). Conclusion 0.2% ropivacaine combined with 2mg morphine may be the optimal dose with better analgesic effect and less adverse events for epidural anesthesia during nonintubated thoracoscopic wedge resection. |
| Key words: Ropivacaine Epidural anesthesia Thoracoscopy Wedge resection |
