摘要
目的探讨罗哌卡因用于单孔胸腔镜肺叶切除术椎旁神经阻滞的半数有效浓度。方法拟行单孔胸腔镜肺叶切除术的患者34例,在超声引导下行椎旁神经阻滞。将0.3%罗哌卡因0.3 mL/kg作为初始浓度,如果第1例患者达到最佳有效镇痛标准(有效),则第2例患者的局部麻醉药容量下降1个阶梯(减少0.02%);如果第1例患者未达到最佳有效镇痛标准,则第2例患者需增加0.02%;以此类推,直至出现7个未达最佳有效镇痛标准为药物浓度拐点。采用Probit概率单位回归法计算罗哌卡因的半数有效浓度及其95%CI。记录入手术室(T_(0))、阻滞完成(T_(1))、麻醉诱导后(T_(2))、手术切皮前(T_(3))、手术切皮后(T_(4))、手术30 min(T_(5))、手术结束(T_(6))时的心率、平均动脉压、血氧饱和度;分别于阻滞后5 min、2 h、12 h、24 h静息及咳嗽状态下采用疼痛视觉模拟量表(VAS)评估疼痛情况,指导患者使用自控镇痛(PCA)泵及采取补救麻醉措施。结果34例患者中,有效18例、无效16例。有效患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)的心率、平均动脉压低于无效患者,T_(3)的血氧饱和度高于无效患者,拔管后5 min、2 h、12 h、24 h静息和活动时VAS评分低于无效患者(P均<0.05)。有效患者使用PCA泵占比及采取补救措施占比低于无效患者(P均<0.05)。患者麻醉过程中无穿刺部位出血、血肿,无头晕、耳鸣等麻醉药物不良反应,无气胸、血胸等并发症发生。罗哌卡因用于单孔胸腔镜肺叶切除术椎旁神经阻滞的半数有效浓度为0.220%(95%CI:0.197%~0.242%)。结论罗哌卡因用于单孔胸腔镜肺叶切除术椎旁神经阻滞的半数有效浓度为0.220%(95%CI:0.197%~0.242%)。
Objective To determine the median effective concentration of ropivacaine for paravertebral nerve block in single-port thoracoscopic lobectomy.Methods Thirty-four patients scheduled for single-port thoracoscopic lobectomy underwent ultrasound-guided paravertebral nerve block.An initial concentration of 0.3%ropivacaine at 0.3 mL/kg was administered.If the first patient achieved optimal analgesia(effective),the local anesthetic dose for the second patient was reduced by one step(decreased by 0.02%).If the first patient did not achieve optimal analgesia,the second patient's concentration increased by 0.02%.This process continued until seven consecutive patients failed to achieve optimal analgesia,marking the drug concentration inflection point.The Probit probability unit regression method was used to calculate the median effective concentration(EC50)of ropivacaine and its 95%confidence interval(CI).The following parameters were recorded:heart rate,mean arterial pressure,and oxygen saturation at the following time points[entry into the operating room(T_(0)),completion of nerve block(T_(1)),after induction of anesthesia(T_(2)),before surgical skin incision(T_(3)),after surgical skin incision(T_(4)),30 minutes into surgery(T_(5)),and end of surgery(T_(6))].Pain was assessed using the visual analogue scale(VAS)at 5 min,2 h,12 h,and 24 h after block in resting and coughing states,and we instructed the patients in the use of patient-controlled analgesia(PCA)pump and took supplemental anesthesia measures.Results Among 34 patients,18 responded effectively and 16 did not.Effective patients exhibited lower heart rate and mean arterial pressure at T_(1),T_(2),T_(3),T_(4),T_(5),and T_(6),while had higher SpO₂at T_(3),and lower VAS scores at rest and during activity at 5 min,2 h,12 h,and 24 h after extubation than non-responders(all P<0.05).The proportion of responders using the PCA pump and requiring rescue measures was lower than that of non-responders(P<0.05).No bleeding or hematoma at the puncture site,no adverse reactions to local anesthetics such as dizziness or tinnitus,and no complications like pneumothorax or hemothorax occurred during anesthesia.The median effective concentration of ropivacaine for paravertebral nerve block in single-port thoracoscopic lobectomy was 0.220%(95%CI:0.197%-0.242%).Conclusion The median effective concentration of ropivacaine for paravertebral nerve block in single-port thoracoscopic lobectomy was 0.220%(95%CI:0.197%-0.242%).
作者
张世勇
杨正雄
张媛梅
ZHANG Shiyong;YANG Zhengxiong;ZHANG Yuanmei(Department of Anesthesiology,The First People's Hospital of Neijiang,Neijiang 641000,China)
出处
《山东医药》
2025年第9期89-92,99,共5页
Shandong Medical Journal
基金
四川省内江市科技支撑计划项目(Z202203)。
关键词
罗哌卡因
单孔胸腔镜肺叶切除术
椎旁神经阻滞
半数有效浓度
局部麻醉
ropivacaine
single-port thoracoscopic lobectomy
paravertebral nerve block
median effective concentration
local anesthesia
