椎旁间隙神经阻滞在开胸术中的应用  

Application of paravertebral nerve block to thoracotomy

作　　者：侯立朝[1] 张宏[1] 贺柏林[1] 靳冰[1] 

机构地区：[1]解放军总医院麻醉科

出　　处：《军医进修学院学报》1998年第4期291-293,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的：改进开胸麻醉术。方法：２０例３９～７６岁，符合美国麻醉医师协会分级标准（ＡＳＡ）Ⅰ～Ⅱ级的胸科择期手术患者，分为Ａ组（全麻对照组）和Ｂ组（全麻加椎旁阻滞组），各１０例。Ａ组患者吸入七氟醚和静注芬太尼维持麻醉；Ｂ组以椎旁阻滞加吸入七氟醚维持麻醉。结果：Ｂ组患者麻醉维持期七氟醚的吸入气浓度（ＦＩＳＥＶＯ）与Ａ组相比平均下降６２．８％（Ｐ＜０．０１）；Ｂ组麻醉维持期循环变化较平稳，术毕初醒时间和拔管时间均较Ａ组提前（Ｐ＜０．０１），且术毕拔管后切口出现疼痛时间亦延迟６～１０ｈ。结论：椎旁阻滞复合全麻应用于开胸手术可减少全麻药及镇痛药用量，减轻麻醉药副作用，更有利于维持术中血流动力学的稳定，使苏醒加快，拔管提前。Objective:Paravertebral blockade (PVB) combined with general anesthesia for thoracotomy was introduced in this article.Methods:20 patients, aged 39￣76 years, ASA grade Ⅰ￣Ⅱ,were scheduled for selected thoracic surgical operations. They were randomly divided into two groups: group A (general anesthesia only; n =19) and group B (general anesthesia plus PVB; n =10). The patients in group A were maintained by inhaled sevoflurane and intravenous fentanyl, while those in group B were maintained by inhaled sevoflurane plus PVB. The inhaled and exhaled concentrations of sevoflurane were compared between group A and B; And the awake time from anesthesia, the time for extubation, the time for recovery of postoperative pain, as well as the hemodynamics during operation were compared in this two groups. Results:The inhaled concentration of sevoflurane during anesthetic maintenance period declined 62.8% ( P <0.01) in group B than that in group A; the hemodynamic parameters were more stable; the awake time from anesthesia and the time for extubation after operation were shorter in group B (all P <0.01); and the patients in group B felt a wound pain at 6￣10 hours after operation, but those in group A complained pain immediatedly after extubation. Conclusion:PVB combined with general anesthesia applied to thoracotomy may reduce the required dose of general anesthetic or analgesic, thus reduce the side effects of anesthetics, faciliate maintaining the stability of hemodynamics during operation, make the patients more quickly awake from anesthesia, and delay postoperative wound pain.

关 键 词：神经传导 阻滞麻醉 胸部外科手术 

分 类 号：R614.4[医药卫生—麻醉学] R655.5[医药卫生—外科学]