右美托嘧啶联合罗哌卡因胸椎旁神经阻滞对胸腹腔镜联合食管癌根治术患者术后早期恢复质量的影响

发布时间：2018-02-28 23:33

本文关键词： 胸椎旁神经阻滞(TPVB) 早期恢复质量炎症反应右美托嘧啶超声多普勒　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声引导下右美托嘧啶联合罗哌卡因胸椎旁神经阻滞(TPVB)对胸腹腔镜联合食道癌切除术患者术后镇痛、炎症、早期恢复质量的影响。方法:选择行胸腹腔镜联合食道癌切除术患者90例,采用随机数字表法分成三组(每组30人):罗哌卡因TPVB组(TS组)、右美托嘧啶联合罗哌卡因TPVB组(TD组)和对照组(C组)。全身麻醉前15min,TS组、TD组分别在超声引导下行右侧胸6水平椎旁神经阻滞,分别注入0.375%罗哌卡因20ml、lug/kg右美托嘧啶和0.375%罗哌卡因混合液20ml。三组全麻诱导和维持方法一致。三组术毕均采用电子泵静脉自控镇痛。记录术后1h、2h、4h、8h、12h、24h的静息、运动时(咳嗽和深压腹部)疼痛视觉模拟评分(VAS评分);选择术前(T1)、术中胸腔镜进胸时(T2)和术后24h(T3)抽静脉血2ml,检测血浆IL-6、IL-8浓度;记录患者术中丙泊酚、瑞芬太尼用量以及术后一个月内相关并发症的发生率(如肺部感染,肺不张,呼吸衰竭,心律失常等)。采用QoR-40量表评价患者术前、术后3天和术后1个月的早期恢复质量。结果:最终各组分别入选27人。1.与C组相比,TS组,TD组在术后3天,术后1个月时QOR-40总评分均显著增高(p0.01),身体舒适度和情绪更好,自理能力及疼痛管理方面更强(p0.05),而与TS组相比,TD组在上述时间点时身体舒适度更佳(p0.05),同时情绪更乐观,有更好的自理能力与疼痛控制(p0.05),QOR-40总评分更高(p0.05)。2.与C组相比,TD组与TS组静息和运动状态下在术后1h、2h、4h、8h、12h、24h各时刻VAS评分均显著降低(p0.05),而与TS组相比,静息和运动状态下以上各时间点时TD组VAS评分也显著降低(p0.05)。3.与C组相比,TD组与TS组在T2,T3时点血浆IL-6、IL-8水平均显著降低(p0.01),与TS组相比,在T2,T3时点TD组IL-6、IL-8水平显著降低(p0.05)。4.三组患者术后1个月内均无肺部感染、肺不张、呼吸衰竭、心律失常相关并发症。与C组相比,TS、TD组瑞芬太尼用量均明显减少(p0.01),但TS组和TD组相比无差异(p0.05),术中三组患者丙泊酚用量无统计学差异(P0.05)。结论:与单纯全麻相比,胸椎旁阻滞复合全麻对胸腹腔镜食道癌根治术患者而言可以明显减轻术后疼痛,减弱围术期手术炎症反应,减少术中镇痛药物用量,显著提高患者早期术后恢复质量;与单纯罗哌卡因TPVB相比,右美托嘧啶联合罗哌卡因胸椎旁神经阻滞在以上各方面更优,但对于术中镇痛药物用量无影响。
[Abstract]:Objective: to investigate the analgesia and inflammation of patients with thoracic paravertebral nerve block (TPVB) guided by right metopyrimidine and ropivacaine combined with thoracic laparoscopy and esophagectomy. Methods: 90 patients with thoracic laparoscopy combined with esophagectomy were selected. Three groups were randomly divided into three groups: ropivacaine TPVB group (TS group), dexmetropyrimidine combined ropivacaine TPVB group (TD group) and control group (group C). Thoracic 6 level paravertebral nerve block, 0.375% ropivacaine 20ml / kg dexmetropyrimidine and 0.375% ropivacaine were injected into 20ml 20 ml, respectively. The induction and maintenance of general anesthesia in the three groups were the same. The visual analogue score of pain during exercise (cough and deep pressure abdomen) and VAS score were used to measure the plasma IL-6 IL-8 concentration, and to record the propofol during operation. The dosage of remifentanil and the incidence of postoperative complications (such as pulmonary infection, atelectasis, respiratory failure, arrhythmia, etc.) were evaluated by QoR-40 scale before operation. Results: 27 patients were enrolled in each group respectively. Compared with group C, the total QOR-40 score of TD group was significantly higher than that of group C at 3 days and 1 month after operation, and the body comfort and mood were better. Compared with TS group, TD group was more comfortable than TS group in terms of self-care ability and pain management. Compared with group C, the VAS scores of TD and TS groups decreased significantly at 1 h, 2 h, 4 h, 8 h and 12 h at 24 h after operation, and compared with those in TS group, the total score of P0.05 was significantly lower than that in group C, and compared with that in group C, the total score of QOR-40 was significantly lower than that in group C, compared with that in group C, which was significantly lower than that in group C at 1 h, 2 h, 4 h, 8 h, 8 h, 12 h and 24 h after operation, compared with that in group C. The VAS score of TD group was significantly lower than that of group C at rest and exercise. Compared with group C, the levels of IL-6 and IL-8 in TD group and TS group were significantly lower than those in group C at T2T 3, compared with those in TS group. The levels of IL-6 and IL-8 in TD group were significantly decreased at T _ 2 / T _ 3. There was no pulmonary infection, atelectasis, respiratory failure in all three groups within one month after operation. Compared with group C, the dosage of remifentanil decreased significantly in group C, but there was no difference in dosage of propofol between group TS and group TD (P 0.05). Conclusion: compared with general anesthesia alone, the dosage of propofol was not significantly different among the three groups. Thoracic paravertebral block combined with general anesthesia can significantly reduce postoperative pain, reduce perioperative inflammatory reaction, reduce the amount of intraoperative analgesic drugs, and significantly improve the quality of early postoperative recovery in patients with thoracic laparoscopic radical esophagectomy. Compared with ropivacaine TPVB alone, dexmetropyrimidine combined with ropivacaine was better in paravertebral thoracic nerve block than ropivacaine alone, but had no effect on intraoperative analgesic dosage.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.1

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