超声引导下胸椎旁神经阻滞复合全身麻醉对老年肺癌患者应激反应和炎性反应及血流动力学的影响

发布时间：2018-04-27 15:32

本文选题：超声引导 + 胸椎旁神经阻滞　；参考：《中国老年学杂志》2017年24期

【摘要】：目的探讨超声引导下胸椎旁神经阻滞复合全身麻醉对老年肺癌患者应激反应、炎性反应及血流动力学的影响。方法筛选择期行开胸肺癌根治术的老年患者48例,采用随机数字表法将其分为A组(n=16),单纯全身麻醉;B组(n=16),硬膜外阻滞复合全身麻醉;C组(n=16),超声引导下连续胸椎旁神经阻滞复合全身麻醉。分别于5个不同时间点(T0:入室时;T1:胸椎旁及硬膜外注射给药后15 min;T2:诱导插管后;T3:切皮5 min后;T4:拔管前)采集受试者心率(HR)、平均动脉压(MAP)。分别于术后2、12、24及48 h测定血浆白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α及血清皮质醇和C反应蛋白(CRP)浓度。结果相较于T0时刻,A组于T2~T4时刻MAP、HR明显增高,B组于T1~T4时刻MAP、HR明显降低,C组MAP、HR未发生显著变化(P0.05)。术后各组炎性因子、皮质醇及CRP均较术前显著升高(P0.05);与A组比较,术后各时刻B、C两组IL-6与TNF-α均显著降低,术后12、24、48 h IL-10显著升高(P0.05)。结论连续胸椎旁神经阻滞联合全身麻醉利于维持胸外科手术过程中患者的循环平稳,并且抑制应激水平和炎性反应。
[Abstract]:Objective to investigate the effects of ultrasonic guided paravertebral nerve block combined with general anesthesia on stress response, inflammatory response and hemodynamics in elderly patients with lung cancer. Methods 48 elderly patients with radical resection of lung cancer were selected and divided into group A (n=16), simple general anesthesia, B group (n=16) and epidural block. Combined general anesthesia; group C (n=16), continuous thoracic paravertebral block combined with general anesthesia under ultrasound guidance at 5 different time points (T0: admission; 15 min after T1: thoracic and epidural injection; T2: induced intubation; T3: peel 5 min; T4: before extubation), heart rate (HR), mean arterial pressure (MAP). Respectively, after operation 2,12,24 and 4 respectively. The concentrations of plasma interleukin (IL) -6, IL-10, tumor necrosis factor (TNF) - alpha, serum cortisol and C reactive protein (CRP) were measured by 8 h. Compared with group A (P0.05), the IL-6 and TNF- alpha in group C two were significantly lower and 12,24,48 h IL-10 significantly increased after operation (P0.05). Conclusion continuous paravertebral paravertebral block combined with general anesthesia was beneficial to maintain the stable circulation of patients in the Department of thoracic surgery and inhibit the stress level and inflammatory response.

【作者单位】：天津市第三中心医院心脏中心;北京军区总医院麻醉科;天津市胸科医院心内科;河北省巨鹿县医院麻醉科;
【基金】：2015年中国博士后科学基金资助项目(2015M581308) 天津市科学技术委员会重点项目(No.11ZCGYSY02000) 天津市卫生局重点攻关项目(No.12KG106)
【分类号】：R614;R734.2

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