超声引导下胸椎椎旁神经阻滞复合全身麻醉在肝部分切除术中的应用

发布时间：2018-01-03 17:10

本文关键词：超声引导下胸椎椎旁神经阻滞复合全身麻醉在肝部分切除术中的应用　出处：《新乡医学院学报》2016年04期 　论文类型：期刊论文

【摘要】：目的探讨超声引导下胸椎椎旁神经阻滞(TPVB)复合全身麻醉在肝部分切除术中的应用效果。方法80例择期行肝右叶部分切除术的肝细胞癌患者分为观察组和对照组,每组40例。对照组患者给予喉罩吸入全身麻醉,观察组患者给予超声引导下TPVB复合喉罩吸入全身麻醉;观察2组患者麻醉后加强监护病房(PACU)停留时间、术中及PACU观察期间舒芬太尼使用量、术后48 h疼痛视觉模拟评分(VAS)4的病例数、术后48 h内患者单次使用自控静脉镇痛(PCIA)次数及术后并发症发生情况。结果 2组患者手术时间、术中出血量、补液量及尿量比较差异均无统计学意义(P0.05)。术前、切皮时、术中30 min时2组患者平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2)及体温比较差异均无统计学意义(P0.05);手术结束拔除喉罩后患者Aldrete评分达到出苏醒室标准时观察组患者MAP、HR低于对照组(P0.05),但2组患者Sp O2及体温比较差异无统计学意义(P0.05)。观察组患者PACU停留时间显著短于对照组(P0.01),观察组患者术中及在PACU停留期间舒芬太尼使用量均显著少于对照组(P0.01)。术后1、6、12 h,观察组疼痛VAS评分4的患者例数显著少于对照组(P0.05)。在术后0~1、1~6、6~12、12~24及0~48 h,观察组患者单次使用PCIA的次数显著少于对照组(P0.05,P0.01)。观察组患者术后恶心呕吐及呼吸抑制发生率显著低于对照组(P0.05)。结论超声引导下TPVB复合喉罩吸入全身麻醉可以减少术中和术后阿片类药物使用量,缩短PACU停留时间,减轻患者术后疼痛,减少术后并发症。
[Abstract]:Objective to investigate the thoracic paravertebral nerve block (TPVB) guided by ultrasound. Methods 80 patients with hepatocellular carcinoma undergoing partial hepatectomy were divided into observation group and control group. 40 cases in each group. The patients in the control group were given laryngeal mask inhalation general anesthesia, while the patients in the observation group were given TPVB combined laryngeal mask inhalation general anesthesia under the guidance of ultrasound. The duration of stay in intensive care unit after anesthesia, the amount of sufentanil used during operation and PACU observation, and the number of patients with visual analogue score of pain and visual analogue score of VAS4 at 48 hours after operation were observed in both groups. Results the time of operation and the amount of blood loss during operation were observed in two groups. There was no significant difference in fluid resuscitation and urine volume between the two groups (P 0.05). The mean arterial pressure (MAPP) and heart rate (HR) were observed in the two groups at 30 min before operation and 30 min after skin incision. There was no significant difference in blood oxygen saturation (Sp O 2) and body temperature (P 0.05). At the end of operation, the Aldrete score of patients with laryngeal mask was lower than that of the control group (P 0.05). However, there was no significant difference in SPO _ 2 and body temperature between the two groups. The PACU residence time in the observation group was significantly shorter than that in the control group (P 0.01). The dosage of sufentanil during operation and stay in PACU in the observation group was significantly lower than that in the control group (P 0.01). The number of patients with pain VAS score 4 in the observation group was significantly lower than that in the control group (P 0.05). The frequency of single use of PCIA in the observation group was significantly lower than that in the control group (P0.05). The incidence of nausea and vomiting and respiratory depression in the observation group was significantly lower than that in the control group (P 0.05). Conclusion Ultrasound-guided TPVB combined with laryngeal mask inhalation general anesthesia can reduce the use of opioid drugs during and after operation. The duration of PACU stay was shortened, the postoperative pain was alleviated, and postoperative complications were reduced.
【作者单位】：佛山市顺德区均安医院麻醉科;
【分类号】：R614;R735.7
【正文快照】： 肝细胞癌(hepatocellular carcinoma,HCC)是常见的恶性肿瘤,肝部分切除术(partial hepatectomy,PH)是肝细胞癌有效的治疗方法[1]。由于该手术创伤大,牵拉反应明显,肌肉松弛要求高等,PH常在气管插管全身麻醉或喉罩(laryngeal mask airway,LMA)通气全身麻醉下进行,但全身麻醉后

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