摘要
目的探讨超声引导连续胸椎旁神经阻滞镇痛对食管癌手术患者围手术期应激反应的影响。方法选择择期食管癌开胸手术患者80例，按随机数字表法分为连续胸椎旁神经阻滞复合连续静脉自控镇痛组（A组，40例）和单纯连续静脉自控镇痛组（B组，40例）。两组均实施双腔气管插管人工通气下全身麻醉。A组于全身麻醉诱导前行超声引导下连续胸椎旁神经阻滞，术后采用连续椎旁神经阻滞镇痛复合患者静脉自控镇痛（PCIA），B组采用单纯PCIA。记录患者术中全身麻醉药物用量及麻醉前（T1）、诱导前（T2）、气管插管即刻（T3）、手术2h（T4）、术毕（T5）、术后1h（T6）、术后8h（T7）、术后24h（T8）、术后48h（T9）的收缩压（SBP）、舒张压（DBP）、心率（HR）、动脉血氧饱和度（SpO2），记录T6～T10时疼痛视觉模拟量表（VAS）评分、Ramsay镇静评分，并于T1、T4、T5、T9时中心静脉采血检测血糖、肾上腺素（E）、去甲肾上腺素（NE）、多巴胺（DA）水平。结果A组患者术中丙泊酚、瑞芬太尼用量明显少于B组[（960．0±216．9）mg比（1242．5±200．2）mg，（1．5±0．4）mg比（2．3±0．4）mg]，差异有统计学意义（P〈0．05）。两组患者均顺利完成手术，术中生命体征平稳。术后A组T6～T9时间点安静时和活动时VAS评分均明显低于同期B组（P〈0．05）。两组各时间点Ramsay镇静评分比较差异无统计学意义（P〉0．05）。两组T9时血糖、NE均明显高于本组T1、T4、T5时（P〈0．05）。两组T4、T5时E水平均明显低于本组T1、T9时（P〈0．05）。B组T9时DA明显高于本组T1、T4、T5时（P〈0．05）。A组T9时血糖、NE、E、DA均明显低于同期B组（P〈0．05）。结论超声引导连续胸椎旁神经阻滞复合连续静脉自控镇痛用于食管癌手术的术后镇痛安全有效，能更好地抑制应激反应，并且可以减少术中全身麻醉药物的使用。
Objective To investigate the effect of ultrasound-guided paravertebral nerve block on stress reaction in patients undergoing esophageal resection. Methods Eighty patients scheduled to do the operation of esophageal resection were randomly divided into two groups with 40 cases in each group. The patients in group A were given the general anesthesia combined with ultrasound-guided paravertebral block, and the patients in group B were given the general anesthesia only. Both of two groups received postoperative patient controlled intravenous analgesia （PCIA）. The amount of propofol and remifen-tanil used were recorded. The data of blood pressure, heart rate （HR） and pulseoxygen saturation （SpO2） before anesthesia （T1）, before induction （T2）, after intubation （T3）, in 2 h of surgery （T4）, after surgery （Ts）, 1 b after surgery （T6）, 8 h after surgery （T7）, 24 h after surgery （T8）, 48 h after surgery （Tg）were recorded. The analgesic effect was measured by VAS scores and Ramsay sedation scores were also recorded at T6- T10. The levels of blood glucose, epinephrine （E）, norcpinephrinc （NE） and dopamiue （DA） were also detected at T1, T4, T5, T9. Results The amount of propofol and remifentanil used in group A were lower than those in group B： （960.0 ± 216.9） mg vs. （1 242.5 ± 200.2） mg, （1.5 ± 0.4） mg vs. （2.3 ± 0.4） mg, P 〈 0.05. The patients in two groups successfully completed surgery, and intraoperative vital signs was stable. The quiet and active VAS scores at T6 - T9 in group A were significantly lower than those in group B （P 〈 0.05）. The Ramsay sedation scores at each time point in two groups had no significant differences （P 〉 0.05）. The levels of blood glucose and NE at q＇9 were significantly higher than those at T1, T4 or T5 of same group, P 〈 0.05.The level of E at T4 and Ts was significantly lower than that at T1 and T9 of same group, P 〈 0.05. The level of DA at T9 was significantly higher than that at T1, T4 and T5 in group B （P 〈 0.05）. The levels of blood glucose, NE, E and DA at T9 in group B were significantly higher than those in group A （P 〈 0.05）. Conclusions General anesthesia combined with ultrasoundguided paravertebral nerve block could offer favorable anaesthesia effect. It could decrease stress reaction and anesthetics requirements in patients undergoing esophageal resection.
出处
《中国医师进修杂志》
2016年第5期456-460,共5页
Chinese Journal of Postgraduates of Medicine
基金
河南省教育教学改革研究项目（2012SJGLX200）
河南省卫生科技创新性人才工程基金（20114155）
关键词
麻醉
全身
胸椎旁神经阻滞
超声引导
应激反应
Anesthesia, general
Paravertebral nerve blockade
Ultrasound-guided
Stress reaction
