Narcotrend监测下全身麻醉复合椎旁神经阻滞用于胸腹腔镜联合食管癌根治术效果观察

发布时间：2018-01-11 19:09

本文关键词：Narcotrend监测下全身麻醉复合椎旁神经阻滞用于胸腹腔镜联合食管癌根治术效果观察　出处：《山东医药》2016年40期 　论文类型：期刊论文

【摘要】：目的观察Narcot_rend监测下全身麻醉复合椎旁神经阻滞(PVB)在胸腹腔镜联合食管癌根治术(TLE)中的应用效果及安全性。方法选择择期行TLE的食管癌患者50例,随机分为全身麻醉组(G组)、PVB复合全身麻醉组(P+G组),每组25例。G组直接予以全身麻醉,P+G组在超声引导下行PVB,右T5椎旁间隙、双侧T8椎旁间隙分别予以0.5%罗哌卡因10 m L,记录起效时间、阻滞平面后,予以全身麻醉;术中监测平均动脉压(MAP)、心率(HR)、Narcot_rend指数(NTI)[分别记录基础时(t_0)、神经阻滞后全麻诱导前(t_1)、全麻诱导后(t_2)、胸腔镜手术切皮时(t_3)、胸腔镜手术1 h时(t_4)、腹腔镜手术切皮时(t_5)、腹腔镜手术1 h时(t_6)、手术结束时(t_7)、气管拔管时(t_8)、出麻醉恢复室(PACU)时(t_9)];术毕两组均予舒芬太尼静脉镇痛,记录术中丙泊酚、瑞芬太尼用量;记录拔管时间、PACU停留时间;记录患者术后安静和咳嗽时视觉模拟评分(VAS)、舒芬太尼用量、并发症发生情况等。结果P+G组感觉阻滞平面右侧为T3~11,左侧为T6~11。与G组比较,P+G组术中丙泊酚、瑞芬太尼用量减少(P均0.05),清醒至拔管时间、PACU停留时间缩短(P0.05或0.01);两组t_8和t_9时点MAP均升高,但P+G组升高幅度均小于G组(P均0.05);P+G组t_3、t_4、t_6时点NTI均高于G组同时点(P均0.05);P+G组术后8 h内安静和咳嗽时VAS、舒芬太尼用量均低于G组(P均0.05)。两组均未发生术中知晓。结论 Narcot_rend监测下PVB复合全身麻醉用于TLE的麻醉深度适宜,镇痛效果较好,术中血流动力学稳定。
[Abstract]:Objective to observe the application of general anesthesia combined with paravertebral nerve block under Narcot_rend monitoring in thoracic laparoscopy combined with radical resection of esophageal carcinoma. Methods 50 patients with TLE were selected. The patients were randomly divided into general anesthesia group (group G) and general anesthesia group (group P G). 25 patients in each group were given PVB under ultrasound guidance. Right T5 paravertebral space and bilateral T8 paraspinal space were treated with 0.5% ropivacaine 10 mL, respectively. The onset time was recorded. After block plane, general anesthesia was given. Intraoperative monitoring of mean arterial pressure MAPV, heart rate (HRT) and Narcottirend index (NTI). [The number of cases were recorded respectively, after general anesthesia induction, before general anesthesia induction, after general anesthesia induction, after general anesthesia induction, after general anesthesia induction, at the time of skin incision by thoracoscopic surgery, at T _ 3s, and at 1 hour after thoracoscopic surgery, by T _ 4). At the end of the operation, there were 5 cases of skin incision, 1 hour of laparoscopic surgery, 1 hour of operation, 1 hour after operation, and 1 hour after operation. At the end of the operation, there was no significant difference between the two groups, and at the end of the operation, there was no significant difference between them. When the anaesthesia recovery room (PACUU) is out of the anaesthesia recovery room, there is no t _ (9)]; Both groups were given sufentanil intravenous analgesia at the end of operation. The dosage of propofol and remifentanil were recorded. The time of extubation and the residence time of PACU were recorded. Visual analogue score (VASA), sufentanil dosage and complications were recorded during postoperative quiet and cough. Results the right side of sensory block level in group P G was T 3n 11. Compared with group G, the dosage of propofol and remifentanil were decreased by 0.05, and the time from waking to extubation. The residence time of PACU was shortened (P0.05 or 0.01). At the time points of t8 and t9, MAP increased in both groups, but the amplitude of increase in group P G was lower than that in group G (P 0.05). The NTI at the time point of T _ 3 / T _ 4 / T _ 6 in group P _ G was higher than that in group G (P < 0.05). In P G group, VAS occurred at rest and cough within 8 hours after operation. The dosage of sufentanil was lower than that of group G (P < 0.05). There was no intraoperative knowledge in both groups. Conclusion PVB combined with general anesthesia under Narcot_rend monitoring is suitable for TLE anesthesia. The analgesic effect was better and hemodynamics was stable during operation.
【作者单位】：安徽医科大学附属省立医院;
【分类号】：R614
【正文快照】： 硬膜外镇痛是胸腹腔镜联合食管癌根治术(TLE)传统的镇痛方法。但随着抗凝药物的广泛使用,极易诱发硬膜外血肿;而且静脉麻醉随着麻醉药用量的增加,会导致患者嗜睡,影响术后咳嗽、咳痰及下床活动。椎旁神经阻滞(PVB)推荐用于胸科手术镇痛,其用于TLE术后镇痛鲜有报道[1]。在全身

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