超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响

发布时间：2018-05-09 08:59

本文选题：胸椎旁神经阻滞 + 超声引导　；参考：《临床麻醉学杂志》2015年01期

【摘要】：目的观察超声引导胸椎旁神经阻滞对食管癌手术患者循环及应激反应的影响。方法择期食管癌开胸手术患者40例,随机均分为胸椎旁神经阻滞复合全麻组(A组)和单纯全麻组(B组)。两组全麻方法相同,A组于全麻诱导前行超声引导下胸椎旁神经阻滞,术后两组均采用患者静脉自控镇痛(PCIA)。记录患者全麻药物用量及麻醉前(T1)、诱导前(T2)、气管插管即刻(T3)、手术2h(T4)、术毕(T5)、术后1h(T6)、4h(T7)、8h(T8)、24h(T9)、48h(T10)的SBP、DBP、HR、SpO2,记录T6~T10时疼痛VAS评分、Ramsay镇静评分,并于T1、T4、T5、T9时抽血检测血糖、肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)浓度。结果 A组患者术中丙泊酚用量、瑞芬太尼用量明显少于B组(P0.05)。两组患者术中血流动力学平稳,术后A组T6~T9安静时和活动时的疼痛VAS评分均明显低于B组(P0.05),Ramsay镇静评分差异无统计学意义。两组T9时血糖、NE均明显高于T1、T4、T5时,T4、T5时E均明显低于T1、T9时,B组T9时DA明显高于T1、T4、T5时(P0.05),B组T9时血糖、NE、E、DA均明显高于A组(P0.05)。结论超声引导胸椎旁神经阻滞复合全麻用于食管癌手术安全有效,较单纯全麻能更好地抑制应激反应,减少全麻药物的使用。
[Abstract]:Objective to observe the effect of thoracic paravertebral nerve block guided by ultrasound on circulation and stress response in patients with esophageal carcinoma. Methods 40 patients with esophageal carcinoma undergoing thoracotomy were randomly divided into two groups: group A (group A) with paraspinal nerve block combined with general anesthesia (group A) and group B (group B) with simple general anesthesia. The two groups had the same general anesthesia method: group A was guided by ultrasound to block the paravertebral nerve before induction of general anesthesia, and both groups were treated with PCIA after operation. The dosage of general anesthetic and the time before anesthesia were recorded. Before induction, T2 was induced, T3 was immediately inserted in tracheal intubation, 2 h after operation, T5 was completed, and 1 h after operation, T6, T6, T7, T7, T7, T8, T9, T10) were recorded. The VAS score of pain during T6~T10 was measured by Ramsay sedative score and blood glucose was measured at T1 T4T5 / T9. The concentration of epinephrine, norepinephrine (NE), dopamine (DA). Results the dosage of propofol and remifentanil in group A was significantly lower than that in group B (P 0.05). The hemodynamics of the two groups was stable during operation, and the VAS score of T6~T9 in group A was significantly lower than that in group B during rest and movement, and there was no significant difference in sedative score between group A and group B. In both groups, blood glucose NE at T9 was significantly higher than that in T1T4, T5, T4 and T5 were significantly lower than that in T9 and DA in T9 was significantly higher than that in T9 in T1, T0. 05 and T5 in T9, and higher in Group A than that in Group A at T9, and in Group B, it was significantly higher than that in Group A at T9, and that in Group B was significantly higher than that in Group A. Conclusion Ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia is safe and effective in the operation of esophageal carcinoma. It is more effective than general anesthesia alone in inhibiting stress response and reducing the use of general anesthesia drugs.
【作者单位】：江苏省肿瘤医院麻醉科;
【基金】：江苏省肿瘤医院青年基金(ZQ201204)
【分类号】：R614;R735.1

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