胸椎旁神经阻滞联合腹横肌平面阻滞在二切口食管癌根治术中的临床应用效果观察  

Clinical application of thoracic paravertebral nerve block combined with transversus abdominis plane block in two-incision esophagectomy

作　　者：陈思慧 王龙[1] 周芹[1] CHEN Sihui;WANG Long;ZHOU Qin(Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China;Department of Anesthesiology, Jingmen No.1 People’s Hospital, Jingmen 448000, Hubei, China)

机构地区：[1]武汉大学人民医院麻醉科,武汉430060 [2]荆门市第一人民医院麻醉科,湖北荆门4480000

出　　处：《癌症进展》2019年第12期1407-1411,共5页Oncology Progress

摘　　要：目的观察超声引导下胸椎旁神经阻滞(TPVB)联合腹横肌平面阻滞(TAPB)在二切口食管癌根治术中的临床应用效果。方法采用随机数字表法将68例择期行全身麻醉下二切口食管癌根治术的食管癌患者随机分为观察组(在全身麻醉的基础上采用TPVB联合TAPB)和对照组(采用连续硬膜外间隙阻滞麻醉复合全身麻醉),每组34例。两组患者术毕均采用静脉自控镇痛泵进行镇痛。比较两组患者麻醉诱导前(T0)、诱导时(T1)、手术过程中(T2)、拔管时(T3)、拔管后30min(T4)的基础生命体征[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)]变化情况,记录患者的手术时间、术中出血量、术中血管活性药物总用量和拔管时间,采用视觉模拟评分(VAS)法评价患者术后苏醒时以及术后2、6、12、24、48h的镇痛效果,并记录48h内患者的镇痛泵按压次数和不良反应发生情况。结果在T1、T2时间点,对照组患者的SBP、DBP、MAP与HR均低于同时间点的观察组,差异均有统计学意义(P﹤0.05);在T0、T3、T4时间点,两组患者的SBP、DBP、MAP、HR和SpO2比较,差异均无统计学意义(P﹥0.05)。观察组患者术中使用去甲肾上腺素的总量明显少于对照组患者(P﹤0.01)。术后12、24h时,对照组患者的VAS评分均高于观察组患者(P﹤0.05);两组患者其余时间点(苏醒时及术后2、6、48h)的VAS评分比较,差异均无统计学意义(P﹥0.05)。术后48h内,对照组的静脉镇痛泵按压次数多于观察组(P﹤0.05);两组患者的不良反应发生情况比较,差异无统计学意义(P﹥0.05)。结论在全身麻醉的基础上应用超声引导下TPVB联合TAPB在二切口食管癌根治术中的镇痛效果确切,具有早期术后镇痛的作用,术中患者的循环较稳定,值得在临床中推广应用。Objective To observe the clinical application of ultrasound- guided thoracic paravertebral nerve block (TPVB) combined with transversus abdominis plane block (TAPB) in two-incision esophagectomy. Method Sixty-eight patients administered with elective two-incision esophagectomy with general anesthesia were randomly allocated into two groups as study group (TPVB combined with TAPB on the basis of general anesthesia) and control group (continuous epidural anesthesia on the basis of general anesthesia), with 34 cases in each. Intravenous self-controlled analgesia pumps were used in the two groups for postoperative analgesia. The changes of basic vital signs [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2)] before anesthesia induction (T0), during induction (T1), during operation (T2), extubation (T3), and 30 minutes after extubation (T4) were compared between the two groups, and the operative time, intraoperative blood loss, intraoperative dosage of vasoactive drug and extubation time were recorded. Visual analogue scale (VAS) was used to evaluate the analgesic effect when patients woke up from anesthesia, and at 2 h, 6 h, 12 h, 24 h and 48 h after operation. The frequency of analgesic pump presses within 48 h and the incidence of adverse reactions were recorded. Result At the T1 and T2, the SBP, DBP, MAP and HR were significantly lower in the control group than in the study group (P<0.05);and no significant differences were found in SBP, DBP, MAP, HR and SpO2 at T0, T3, and T4 (P>0.05). There was more norepinephrine consumption in the control group than in the study group (P<0.01). At 12 h and 24 h after operation, the VAS scores in the control group were higher than those in the study group (P<0.05);while there was no significant difference regarding the VAS scores at other time points (waking up, 2 h, 6 h and 48 h after surgery)(P>0.05). Within 48 h after surgery, higher frequency of analgesic pump presses in control group

关 键 词：胸椎旁神经阻滞 腹横肌平面阻滞 多模式镇痛 二切口食管癌根治术 全身麻醉 

分 类 号：R735.1[医药卫生—肿瘤]