右美托咪定联合胸椎旁神经阻滞对开胸手术患者术后镇痛及睡眠质量的影响

摘要

目的 探讨右美托咪定联合胸椎旁神经阻滞(TPVB)对开胸手术患者术后镇痛及睡眠质量的影响.方法 选择全麻下单侧开胸肺癌根治手术患者60例,采用随机数字表法分为两组(各30例):椎旁神经阻滞组(TPVB组)和椎旁神经阻滞+右美托咪定组(TPVB+DEX组).所有患者均于术毕行超声引导下术侧TPVB,术后给予患者自控静脉镇痛(PCIA),TPVB+DEX组在TPVB组PCIA用药的基础上加用3 μg/kg的右美托咪定.记录患者术后2 h、4 h、8 h、24 h、48 h静息和咳嗽时的视觉模拟疼痛评分(VAS)、Ramsay镇静评分,术后48 h舒芬太尼累积消耗量和不良反应发生率;采用医学结局研究睡眠量表(MOS-SS)记录术前1周和术后1周平均每日睡眠时间和睡眠障碍指数(SPI),于术日晚和术后第1天进行主观睡眠质量评分;采用多维疲乏量表(MFI-20)于术后1周对患者疲劳状况进行评定,并记录术后住院时间.结果 两组术后各时点静息和咳嗽时VAS评分差异无统计学意义(P ＞0.05);与术前比较,TPVB组术后1周平均每日睡眠时间缩短,SPI升高(P＜0.05),TPVB+DEX组差异无统计学意义(P＞0.05);与TPVB组比较,TPVB+DEX组术后各时点Ramsay评分升高,术后48 h舒芬太尼累积使用量减少,不良反应减少,术后1周平均每日睡眠时间延长,SPI降低,术日当晚和术后第1天主观睡眠质量评分升高,术后1周心理、躯体和精神疲劳程度降低,术后住院时间缩短(P＜0.05).结论 右美托咪定复合舒芬太尼自控静脉镇痛联合胸椎旁神经阻滞用于开胸手术患者术后镇痛,可取得良好镇痛效果,改善患者睡眠质量,减轻术后疲乏程度,促进患者术后快速康复.%Objective To explore effects of Dexmedetomidine(DEX)combined with thoracic paravertebral nerve block(TPVB)on postoperative anangesia and sleep quality in patients underwent thoracotomy.Methods Sixty pa-tients scheduled for thoracotomy were randomly assigned into TPVB group and TPVB+DEX group with 30 patients in each group.All patients received ultrasound guided TPVB of the operation side and were treated with patient controlled intravenous analgesia(PCIA)after surgery.3 μg/kg of DEX was added to PCIA on the basis of TPVB in TPVB+DEX group.Both resting and coughing visual analogue scales(VAS)and Ramsay sedation scores were recorded at 2 h,4 h, 8 h,24 h and 48 h after surgery.Sufentanil accumulative consumption and incidence of adverse events 48 h after sur-gery were also recorded.The average time of daily sleep and sleep problems index(SPI)were recorded 1 week before and after surgery using medical outcomes study sleep scale(MOS-SS).Subjective sleep quality score was assessed on the night of surgery and one day after surgery.The fatigue status of patients was evaluated using multi-dimensional fatigue inventory-20(MFI-20)1 weeks after surgery.Hospital stay was also recorded after surgery.Results There was no significant difference in resting and coughing VAS between the two groups at all time points(P ＞0.05).The average time of daily sleep was shorter and SPI was higher 1 week after surgery than those before surgery in TPVB group (P ＜0.05).There were no significant differences on average time of daily sleep and SPI 1 week after surgery and be-fore surgery in TPVB+DEX group(P ＞0.05).Compared with TPVB group,the Ramsay sedation scores increased at all time points after surgery,Sufentanil accumulative consumption and incidence of adverse events 48 h after surgery decreased,the average time of daily sleep prolonged and SPI decreased 1 week after surgery,subjective sleep quality score increased on the night of surgery and 1 day after surgery,psychological fatigue,physical fatigue and mental fa-tigue scores decreased 1 week after surgery,hospital stay after surgery shortened in TPVB+DEX group(P ＜0.05). Conclusion DEX combined with TPVB on postoperative anangesia can obtain good analgesic effect,improve sleep quality,alleviate postoperative fatigue and promote rapid rehabilitation after surgery.