高原低氧环境下胸椎旁神经阻滞对老年开胸患者应激反应、循环功能及术后镇痛的影响

发布时间：2018-04-12 01:03

本文选题：高原低氧环境 + 胸椎旁神经根阻滞　；参考：《中国老年学杂志》2017年10期

【摘要】：目的探讨胸椎旁神经阻滞(TPVB)对高原低氧环境下老年开胸患者应激反应、循环功能及术后镇痛效果的影响。方法选择2013年4月至2015年4月拟行开胸手术的老年患者86例,采用随机数字表法分为观察组和对照组各43例,均给予全身麻醉,对照组术后采用静脉自控镇痛,观察组采用超声引导下胸椎旁神经阻滞,比较两组不同时点应激反应、循环功能、疼痛程度及不良反应。结果气管插管即刻(T1)、气管插管后30 min(T2)、手术结束时(T3)观察组血清肾上腺素(E)、去肾上腺素(NE)、多巴胺(DA)含量均明显低于对照组(P0.001);T1、T2、T3时点,观察组心率(HR)明显高于对照组,平均动脉血压(MAP)明显低于对照组(P0.05);术后1、6、24、48 h,观察组静止和咳嗽、活动状态时疼痛评分均明显低于对照组(P0.05或P0.001);术后恶心、呕吐、呼吸抑制等不良反应明显低于对照组(20.93%vs 73.71%,9.30%vs 25.58%,2.33%vs27.91%)(χ~2=3.957~10.965,P0.05,P0.001)。结论超声引导下TPVB麻醉有助于减轻高原地区低氧环境下老年开胸手术患者应激反应,维持血流动力学相对稳定,缓解术后疼痛程度,减少术后并发症的发生。
[Abstract]:Objective to investigate the effects of thoracic paraspinal nerve block (TPVB) on stress response, circulatory function and postoperative analgesia in elderly patients with thoracotomy under high altitude hypoxia.Methods 86 elderly patients undergoing thoracotomy from April 2013 to April 2015 were randomly divided into observation group (n = 43) and control group (n = 43).The stress response, circulatory function, pain degree and adverse reaction were compared between the two groups under ultrasound guided paraspinal nerve block.Results the serum levels of epinephrine, noradrenaline and dopamine were significantly lower in the observation group than in the control group at 30 min after tracheal intubation and 30 min after tracheal intubation, and at the end of the operation. The heart rate of the observation group was significantly higher than that of the control group.Conclusion Ultrasound-guided TPVB anesthesia can reduce stress response, maintain hemodynamic stability, relieve postoperative pain and reduce postoperative complications in elderly patients undergoing thoracotomy under high altitude hypoxia.
【作者单位】：西宁市第三医院麻醉科;
【分类号】：R614

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