浙江医学2017，Vol.39Issue(5)：374-377,4.DOI:10.12056/j.issn.1006-2785.2017.39.5.2016-766
不同浓度罗哌卡因胸段硬膜外麻醉在非插管胸腔镜肺叶楔形切除术中的效果观察
Efficacy of ropivacaine with different concentrations on non-intubated thoracoscopic wedge resection under thoracic epidural anesthesia
朱斌斌 1孙健 1陈福贵 1张瑞 1桂煜1
作者信息
- 1. 315000 宁波大学医学院附属医院麻醉科
- 折叠
摘要
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.关键词
罗哌卡因/硬膜外麻醉/胸腔镜手术/楔形切除Key words
Ropivacaine/Epidural anesthesia/Thoracoscopy/Wedge resection引用本文复制引用
朱斌斌,孙健,陈福贵,张瑞,桂煜..不同浓度罗哌卡因胸段硬膜外麻醉在非插管胸腔镜肺叶楔形切除术中的效果观察[J].浙江医学,2017,39(5):374-377,4.
