超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响  

The effect of ultrasound-guided paravertebral block on stress reaction in patients undergoing esophageal surgery

作　　者：辜晓岚[1] 何建华[1] 顾连兵[1] 

机构地区：[1]江苏省肿瘤医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2015年第1期18-21,共4页Journal of Clinical Anesthesiology

基　　金：江苏省肿瘤医院青年基金(ZQ201204)

摘　　要：目的观察超声引导胸椎旁神经阻滞对食管癌手术患者循环及应激反应的影响。方法择期食管癌开胸手术患者40例,随机均分为胸椎旁神经阻滞复合全麻组（A组）和单纯全麻组（B组）。两组全麻方法相同,A组于全麻诱导前行超声引导下胸椎旁神经阻滞,术后两组均采用患者静脉自控镇痛（PCIA）。记录患者全麻药物用量及麻醉前（T1）、诱导前（T2）、气管插管即刻（T3）、手术2h（T4）、术毕（T5）、术后1h（T6）、4h（T7）、8h（T8）、24h（T9）、48h（T10）的SBP、DBP、HR、SpO2,记录T6～T10时疼痛VAS评分、Ramsay镇静评分,并于T1、T4、T5、T9时抽血检测血糖、肾上腺素（E）、去甲肾上腺素（NE）、多巴胺（DA）浓度。结果 A组患者术中丙泊酚用量、瑞芬太尼用量明显少于B组（P〈0.05）。两组患者术中血流动力学平稳,术后A组T6～T9安静时和活动时的疼痛VAS评分均明显低于B组（P〈0.05）,Ramsay镇静评分差异无统计学意义。两组T9时血糖、NE均明显高于T1、T4、T5时,T4、T5时E均明显低于T1、T9时,B组T9时DA明显高于T1、T4、T5时（P〈0.05）,B组T9时血糖、NE、E、DA均明显高于A组（P〈0.05）。结论超声引导胸椎旁神经阻滞复合全麻用于食管癌手术安全有效,较单纯全麻能更好地抑制应激反应,减少全麻药物的使用。Objective To investigate the effect of ultrasound-guided paravertebral block on hemodynamic index and stress reaction in patients undergoing esophageal surgery.Methods Forty patients scheduled for esophageal surgery were randomly divided into two groups with 20 cases each.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.Both two groups received postoperative patient controlled intravenous analgesia（PCIA）.The amount of propofol and remifentanil used was recorded.Before and after surgery the blood pressure（BP）,heart rate（HR）and pulse oxygen saturation（SpO2）were recorded.The analgesic effect was measured by VAS pain scores at 1h（T6）,4h（T7）,8h（T8）,24h（T9）,48h（T10）after surgery,and Ramsay sedation scores were also recorded.The value of blood glucose,the plasma concentrations of epinephrine（E）,norepinephrine（NE）and dopamine（DA）were also detected at the time before surgery（T1）,2hafter incision（T4）,surgery completion（T5）and 24 hafter surgery（T9）.Results The amount of propofol and remifentanil used was lower in group A than that in group B（P〈0.05）.VAS pain scores were lower in group A than those in group B at T6 to T9.Ramsay sedation scores were not significantly different between the two groups.The value of blood glucose and the concentration of NE at T9 were significantly higher than those at T1,T4 or T5,and the concentration of E at T4 or T5 was significantly lower than that at T1 or T9in each group.The concentration of DA at T9 was significantly higher than that at T1,T4 or T5in group B（P〈0.05）.The concentrations of glucose,NE,E and DA at T9 in group B were significantly higher than those in group A（P〈0.05）.Conclusion General anesthesia combined with ultrasound-guided paravertebral block could offer favorable anaesthesia effect whilemaintaining stable hemodynamic index,and decrease stress reaction and anesthetics req

关 键 词：胸椎旁神经阻滞 超声引导 应激反应 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]