肋间神经阻滞联合全麻在肺癌患者肌肉非损伤性开胸术中的运用  

Usage of intercostal nerve block combining with general anesthesia during muscle-sparing thoracotomy for lung cancer

作　　者：朱敏敏[1,2] 殷曰昊[1,2] 王敬[1,2] 尹华[1,2] 

机构地区：[1]复旦大学附属肿瘤医院麻醉科 [2]复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2010年第5期381-384,共4页China Oncology

摘　　要：背景与目的:全麻联合胸段硬膜外麻醉是近年来开胸手术常用的麻醉方法,但有减弱缺氧性肺血管收缩(hypoxic pulmonary vasoconstriction,HPV)的作用,易导致缺氧的发生。肋间神经阻滞在开胸术后运用,能提供良好的镇痛效果。本文旨在评价肋间神经阻滞联合全麻在开胸术中的镇痛效果以及对HPV的影响。方法:择期行肌肉非损伤性开胸肺癌根治术的患者40例,随机分成2组,单纯全麻(general anesthesia,GA)组和肋间神经阻滞(intercostal nerve block,INB)联合全麻组。术中测量血氧、CO2含量以及舒芬太尼和异丙酚的用量。结果:两组患者肺内分流差异无统计学意义(P>0.05),INB组舒芬太尼和异丙酚的用量显著少于GA组。结论:在肌肉非损伤性开胸术中,肋间神经阻滞联合全麻在开胸手术中能提供较好的镇痛作用,同时在单肺通气中对缺氧性肺血管收缩的影响较小。Background and purpose：In recent years,thoracic epidural anesthesia in combination with general anesthesia has been commonly used in thoracotomy.This anesthesia may decrease hypoxic pulmonary vasoconstriction（HPV）and resulted in the occurrence of hypoxia.Intercostal nerve block,when used postoperative, could provide a good analgesic effect.However,its intraoperative analgesic effect as well as the impact on HPV has been less reported.The purpose of this study was to evaluate the analgesic effect and its impact on the HPV of intercostal nerve block（INB）when combined with general anesthesia（GA）in muscle-sparing thoracotomy for lung cancer.Methods：Forty patients who would undergo muscle-sparing thoracotomy for lung cancer were randomly divided into 2 groups,general anesthesia（GA group）and intercostal nerve block and the general anesthesia group （INB group）.Intraoperative measurement of blood gas and the usage of sufentanil and propofol were used.Results： In terms of the intrapulmonary shunt,there was no statistical difference between the 2 groups.The consumption of sufentanil and propofol in the INB group was significantly lower than in GA group.Conclusion：During the musclesparing thoracotomy for lung cancer,INB combining with GA can provide a better analgesia and have a smaller impact on HPV while one-lung stayed ventilated.

关 键 词：单肺通气 全麻 肋间神经阻滞复合全麻 肺内分流 

分 类 号：R734.2[医药卫生—肿瘤]