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投稿时间：2026-01-12 网络发布日期：2026-07-30
投稿时间：2026-01-12 网络发布日期：2026-07-30
中文摘要: 目的 比较罗哌卡因复合右美托咪定和/或地塞米松，对超声引导下菱形肌-肋间肌-低位前锯肌平面（RISS）阻滞持续时间及镇痛质量的影响。方法 纳入2023年8月至2025年8月秦皇岛市第一医院择期行胸腔镜手术患者90例，按随机数字表法均分为A组、B组和C组，每组各30例。所有患者于全身麻醉后、手术开始前行超声引导RISS阻滞，A组注射0.25%罗哌卡因40 mL；B组给予含右美托咪定1 μg/kg的0.25%罗哌卡因40 mL；C 组给予含右美托咪定1 μg/kg 及地塞米松5 mg 的0.25%罗哌卡因40 mL。比较3 组阻滞时效、术后镇痛时间，不同时间点静息及活动状态视觉模拟（VAS）评分，术后24 h舒芬太尼消耗量、镇痛泵需求次数及补救镇痛实施率，围术期不同时间点［麻醉诱导前（T0），神经阻滞操作前（T1），手术切皮后（T2），拔除气管导管瞬间（T3），拔管后10 min（T4）］的心率与平均动脉压，及并发症发生情况。结果 三组感觉阻滞维持时间及术后镇痛时间呈C组>B组>A 组（P<0.05）。术后6~48 h 各时点静息和活动状态下的VAS 评分呈C 组P<0.05）。术后24 h 舒芬太尼消耗量、镇痛泵需求次数C 组P<0.05）；A 组、B 组和C 组补救镇痛率差异无统计学意义（13.33%，10.00%，6.67%，χ2=0.741，P=0.690）。T2~T4 时点，3 组的心率和平均动脉压呈A 组>C 组>B 组（P<0.05）。A组、B组和C组并发症总发生率比较差异无统计学意义（36.67%，26.67%，16.67%，χ2=3.068，P=0.216）。结论 罗哌卡因复合右美托咪定可显著延长RISS阻滞时程并提升镇痛效果；联合地塞米松后，镇痛时间进一步延长，阿片用量减少，血流动力学更稳定。
Abstract:Objective To compare the effects of ropivacaine combined with dexmedetomidine and/or dexamethasone on the duration of ultrasound - guided rhomboid intercostal subserratus anterior plane （RISS）block and postoperative analgesic quality. Methods A total of 90 patients scheduled for elective thoracoscopic surgery at Qinhuangdao First Hospital from August 2023 to August 2025 were enrolled and equally randomized into Group A，Group B and Group C with 30 cases in each group. Ultrasound-guided RISS block was performed under general anesthesia before surgical incision. Group A received 40 mL of 0.25% ropivacaine；Group B received 40 mL of 0.25% ropivacaine containing 1 μg/kg dexmedetomidine；Group C received 40 mL of 0.25% ropivacaine supplemented with both 1 μg/kg dexmedetomidine and 5 mg dexamethasone. The three groups were compared in terms of block efficacy duration，postoperative analgesia duration，resting and dynamic Visual Analogue Scale（VAS）scores at various time points，24 h postoperative sufentanil consumption，the number of patient-controlled intravenous analgesia（PCIA）pump demands，rescue analgesia rate，perioperative heart rate（HR）and mean arterial pressure（MAP）at T0（before anesthesia induction），T1（before nerve block），T2（after skin incision），T3（at the moment of trachea extubation），T4（10 min post-extubation），and the incidence of complications. Results The sensory block duration and postoperative analgesic duration followed the order：Group C>Group B>Group A（P<0.05）. At 6 to 48 hours after surgery，both resting and dynamic VAS scores were lowest in Group C，followed by Group B and highest in Group A（P<0.05）. The 24-hour sufentanil consumption and the number of PCIA pump demands were also lowest in Group C，intermediate in Group B and highest in Group A（P<0.05）. No significant difference was found in the rescue analgesia rate among the Groups A，B and C（13.33% ，10.00%，6.67%，χ2=0.741，P=0.690）. At T2-T4，HR and MAP were highest in Group A，followed by Group C and lowest in Group B（P<0.05）. The total incidence of postoperative complications showed no statistical difference among Group A，Group B and Group C （36.67% ，26.67% ，16.67% ，χ2=3.068，P=0.216）. Conclusion Ropivacaine combined with dexmedetomidine can significantly prolong RISS block duration and improve postoperative analgesia.Additional administration of dexamethasone further prolongs analgesic duration，reduces opioid consumption and stabilizes perioperative hemodynamics.
keywords: Ropivacaine Dexmedetomidine Dexamethasone Rhomboid intercostal subserratus anterior plane block Analgesia Thoracoscopic surgery
文章编号： 中图分类号：R614 文献标志码：A
基金项目:秦皇岛市科学技术研究与发展计划项目（202501A046）
附件
| 作者 | 单位 |
| 孙东辉 | 1. 秦皇岛市第一医院麻醉科,河北 秦皇岛 066000 |
| 戚小航 | 1. 秦皇岛市第一医院麻醉科,河北 秦皇岛 066000 |
| 张芳 | 2. 秦皇岛市第一医院手术部,河北 秦皇岛 066000 |
| Author Name | Affiliation |
| SUN Donghui*，QI Xiaohang，ZHANG Fang | *Department of Anesthesiology,Qinhuangdao First Hospital,Qinhuangdao,Hebei 066000,China |
引用文本：
孙东辉,戚小航,张芳.罗哌卡因复合不同佐剂对超声引导RISS阻滞时效及镇痛效能的比较[J].中国临床研究,2026,39(7):1000-1004.
孙东辉,戚小航,张芳.罗哌卡因复合不同佐剂对超声引导RISS阻滞时效及镇痛效能的比较[J].中国临床研究,2026,39(7):1000-1004.