超声引导胸椎旁神经阻滞复合丙泊酚在胸腔镜下胸交感神经链切断术中的应用  

The application of ultrasound-guided paravertebral anaesthesia combined with propofol in the thoracoscopic sympathectomy

作　　者：李辉[1] 徐金东[2] 王庆[2] 谢亮[3] 田单[3] 朱亮先[1] 曾丽蓉[1] 王晟[2] LI Hui;XU Jindong;WANG Qing;XIE Liang;TIAN Dan;ZHU Liangxian;ZENG Lirong;WANG Sheng(Department of Anesthesiology ,Xiaolan Peoples Hospital of Zhongshan,Zhangshan 528415 ,China)

机构地区：[1]南方医科大学附属小榄医院麻醉科,广东省中山市528415 [2]广东省医学科学院,广东省人民医院麻醉科,广州市510080 [3]广东省医学科学院,广东省人民医院胸外科,广州市510080

出　　处：《实用医学杂志》2017年第14期2307-2310,共4页The Journal of Practical Medicine

基　　金：广东省建设中医药强省科研基金(编号:20141002);贝朗麻醉科学研究基金(编号:Z022016001)

摘　　要：目的探讨超声引导胸椎旁神经阻滞复合丙泊酚应用于胸腔镜下胸交感神经链切断术的有效性及安全性。方法纳入122例多汗症患者,男63,女59例,将患者分成A组及C组,每组各61例。A组超声引导胸椎旁神经阻滞复合丙泊酚麻醉,C组行常规气管插管静脉全麻,记录两组患者入手术室(T_0)、麻醉完成时(T_1)、切皮时(T_2)、电凝切断T_4交感神经干时(T_3)、手术结束时(T_4)的心率(HR)、平均动脉压(MAP)和脉搏氧饱和度(SpO_2)及术后清醒时间、术后(T2 h、T4 h、T8 h、T12 h、T24 h)VAS评分、术后咽喉不适等。结果两组均顺利完成手术,A组同C组相比,T_0-T_4的HR、MAP和SpO_2无明显差别(P>0.05);术后清醒时间、术后进食时间、术后咽喉不适、住院费用差异有统计意义(P<0.05),A组优于C组;术后VAS评分T2 h、T4 h、T8 h、T12 h,A组优于C组(P<0.05),T24 h两组没有明显差异(P>0.05)。结论超声引导胸椎旁神经阻滞复合丙泊酚麻醉可以安全有效的应用于胸腔镜下胸交感神经链切断术。Objective To investigate the safety and effectiveness of ultrasound?guided paravertebral anaesthesia combined with propofol in the thoracoscopic sympathectomy.Methods Total63male and59female patients with hyperhidrosis were recruited.The patients were equally divided into two groups:group A and C.Patients in group A received ultrasound?guided paravertebral anaesthesia combined with propofol.Patients in group C received general intravenous anesthesia with endotracheal intubation.The heart rate(HR),mean arterial pres?sure(MAP)and the oxygen saturation(SpO2)at the time of entering the operating room(T0),completing anesthesia(T1),incising the skin(T2),cutting the T4sympathetic trunk(T3),completing the operation were recorded.The awake time after operation,VAS score after operation and postoperative throat discomfort were also recorded.Results The two groups successfully completed the surgery.There were no significant differences of the HR,MAP and SpO2at T0-T4between the two groups.There were significant differences of the awake time after operation,postoperative feeding time and hospitalization expenses.The VAS score after operation of group A were better than group C(P<0.05)at T2h,T4h,T8h,and T12h.There was no significant difference of VAS score at T24h between the two groups.Conclusion Ultrasound?guided paravertebral anaesthesia combined with propofol can provide a safe and effective approach for patients receiving the thoracoscopic sympathectomy.

关 键 词：胸椎旁神经阻滞 超声 胸腔镜 胸交感神经链切断术 快速康复 

分 类 号：R614[医药卫生—麻醉学]