Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
Sci Rep. 2017 Jun 21;7(1):3992. doi: 10.1038/s41598-017-04382-5.
The aim of this study was to assess the systemic and analgesic effects of epidural dexmedetomidine in thoracic epidural anaesthesia (TEA) combined with total intravenous anaesthesia during thoracic surgery. Seventy-one patients undergoing open thoracotomy were included in this study and randomly divided into three groups: Control group (Group C): patients received TEA with levobupivacaine alone and were intravenously infused with saline; Epidural group (Group E): patients received TEA with levobupivacaine and dexmedetomidine, and were intravenously infused with saline; Intravenous group (group V): patients received TEA with levobupivacaine alone and were intravenously infused with dexmedetomidine. The doses of propofol used in the induction and maintenance of general anaesthesia, cardiovascular response, dose and first time of postoperative analgesia and verbal rating scale were recorded. The induction and maintenance were significantly lower in the Groups E and V. Verbal rating scale and postoperative analgesic requirements were significantly lower in Group E than in Groups C and V. Patients in Group C had more severe cardiovascular responses, as compared with Groups E and V. Epidural administration of dexmedetomidine reduced the induction and maintenance of propofol, and inhibited the cardiovascular response after intubation and extubation. Moreover, epidural dexmedetomidine provided better analgesia after open thoracotomy.
本研究旨在评估胸段硬膜外麻醉（TEA）联合全静脉麻醉时，硬膜外给予右美托咪定的全身和镇痛效果。本研究纳入了 71 例行开胸手术的患者，并将其随机分为三组：对照组（C 组）：患者接受单独给予左布比卡因的 TEA，并静脉输注生理盐水；硬膜外组（E 组）：患者接受左布比卡因和右美托咪定的 TEA，并静脉输注生理盐水；静脉组（V 组）：患者接受单独给予左布比卡因的 TEA，并静脉输注右美托咪定。记录全身麻醉诱导和维持时丙泊酚的剂量、心血管反应、术后镇痛的剂量和首次使用时间以及口述评分量表。E 组和 V 组的诱导和维持明显较低。E 组的口述评分量表和术后镇痛需求明显低于 C 组和 V 组。与 E 组和 V 组相比，C 组的患者心血管反应更严重。硬膜外给予右美托咪定可降低丙泊酚的诱导和维持，并抑制插管和拔管后的心血管反应。此外，开胸手术后硬膜外给予右美托咪定可提供更好的镇痛效果。
