胸椎旁阻滞对开胸患者开胸前心功能及术后情况的影响  

Effects of thoracic paravertebral block on the heart function and postoperative condition in patients undergoing thoracotomy surgery

作　　者：陈冀衡[1] 范志毅[1] 杨奕[1] 潘振宇[1] 毕素萍[1] 张廷岭[1] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院,北京市肿瘤防治研究所麻醉科,100036

出　　处：《临床麻醉学杂志》2008年第3期197-199,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察胸椎旁阻滞对开胸患者开胸前心功能的影响、术后镇痛及不良反应发生情况。方法开胸手术患者90例,随机均分为全麻组(Ⅰ组)、硬膜外阻滞复合全麻组(Ⅱ组)和胸椎旁阻滞复合全麻组(Ⅲ组)。Ⅱ、Ⅲ组根据手术切口部位在全麻前20min行相应的硬膜外或胸椎旁间隙给药。采用血流动力学监护仪分别于进入手术室后安静状态(T0)、硬膜外或胸椎旁间隙阻滞20min(T1)、全麻诱导后插管前(T2)、气管插管后(T3)4个时段监测三组HR、无创MAP、心排血量(CO)、心脏指数(CI)、加速度指数(ACI)、外周血管阻力(SVR)和收缩时间比率(STR),同时记录ECG和SpO2;并观察术后镇痛情况及不良反应。结果T2时Ⅰ和Ⅱ组HR、MAP、CI、CO、SVR、ACI较T0和Ⅲ组明显下降(P<0·05);STR较Ⅲ组明显上升(P<0·05)。Ⅲ组心电图ST段下移的发生率明显低于Ⅰ组和Ⅱ组(P<0·05)。三组患者对术后镇痛满意率相似。Ⅲ组患者术后并发症明显少于Ⅰ组和Ⅱ组(P<0·05)。结论全麻及硬膜外阻滞复合全麻对开胸患者心功能影响大,术后并发症较多;而椎旁阻滞系单侧脊神经阻滞,复合全麻对心功能和呼吸功能影响相对较轻,适宜于单侧开胸手术及术后镇痛治疗。Objective To explore the effects of thoracic paravertebral block on the heart function before thoracotomy, postoperative analgesia and side-effects. Methods Ninety patients undergoing surgery were randomly divided into group Ⅰ（general anesthesia）, group Ⅱ （general anesthesia combined with epidural block） and group Ⅲ （combined general anesthesia with paravertebral block）. Thoracic epidurial block and paravertebral block were given according to the operate position 20 minutes before general anesthesia. The changes of hemodynamics including heart rate （ HR）, mean artrial pression （ MAP）, cadiac output （ CO）, cadiac index （CI）, accelaration index （ACI） ,systemic vascular resistance（SVR）,systolic time rate （STR） in each group were measured under calm condition after entrance to operation room（T0 ）, at 20 min after never block（T1 ）, before intubation（T2） and after intubation（T3 ）. ECG, SpO2and side effects were recorded. Results Compared with To ,HR,MAP,CI,CO,SVR and ACI of group Ⅰ and Ⅱ were decreased distinctly at T2 （P〈0.05）. In group Ⅲ the incidence of ST descending was distinctly lower than the other two groups （P〈 0.05）. Postoperative antalgic effect of three groups was similar and no side-effects happened in group Ⅲ. Conclusion Combined general anesthesia with epidural block has more disadvantages on hemodynamics than general anesthesia combined paravertebral block in the patients undergoing thoracotomy.

关 键 词：椎旁阻滞 胸段硬膜外阻滞 开胸手术 血流动力学 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]