目的 分析超声下椎旁阻滞联合右美托咪定对开胸手术患者应用效果及对围术期应激影响.方法 选择2016年1月~2016年12月在浙江省湖州市第一人民医院行开胸手术的患者120例为本次研究对象,随机分为观察组和对照组,每组各60例.观察组给予右美托咪定+超声下椎旁神经阻滞,对照组给予罗帕卡因+超声下椎旁神经阻滞.观察2组患者的应用效果及对围术期应激影响.结果 观察组患者术中异丙酚用量、瑞芬太尼用量以及PCIA单位时间用药量均少于对照组,经检验差异有统计学意义(P<0.05).2组患者T2~T3时SBP、DBP、HR较T1明显下降,差异有统计学意义(P<0.05).从组间比较可知,观察组患者的同期VAS评分均低于对照组患者,差异有统计学意义(P<0.05).观察组患者24 h内的追加吗啡率和追加咪达唑仑率高于对照组患者,经检验差异有统计学意义(P<0.05).结论 超声下椎旁阻滞联合右美托咪定应用于开胸手术具有良好的阻滞、镇痛效果,可抑制应激反应,减少术中麻醉用药.%Objective To analyze the effect of paravertebral block combined with dexmedetomidine on thoracotomy in thoracic surgery and its effect on perioperative stress. Methods From January 2016 to December 2016, 120 patients underwent thoracotomy in Huzhou First People's hospital were randomly divided into observation group and control group (60 cases). The observation group was given dexmedetomidine + ultrasound paravertebral nerve block, the control group given ropivacaine + ultrasound paravertebral nerve block. To observe the effect of the two groups of patients and the effect of perioperative stress. Results The levels of propofol, remifentanil and PCIA were significantly lower in the observation group than those in the control group (P<0.05). The levels of SBP, DBP and HR in T2-T3 were significantly lower than those in T1 (P<0.05). Compared with the control group, the VAS score of the observation group was lower than that of the control group, the difference was statistically significant (P<0.05). The addition of morphine and the addition of midazolam in the observation group were higher than those in the control group, the difference was statistically significant (P<0.05). Conclusion Ultrasound with paravertebral block combined with dexmedetomidine in thoracotomy has a good block and analgesic effect, can inhibit stress response and reduce intraoperative anesthesia.
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