双侧胸椎旁阻滞对胸腹腔镜联合食管癌根治术麻醉及术后早期恢复的影响  

Effects of bilateral thoracic paravertebral block on intraoperative anesthesia and early postoperative recovery in patients un dergoing thoracoscopic laparoscopic esophagectomy

作　　者：侯代亮 李成文[2] 宋成伟[2] 张康[3] 张广敬[3] 于宁[1] 王士雷[1] Hou Dailiang;Li Chengwen;Song Chengwei;Zhang Kang;Zhang Guangjing;Yu Ning;Wang Shilei(Department of Anesthesiology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Anesthesiology,Jin ing No.1 People's Hospital,Jining 272011,China;Department of Thoracic Surgery,Jining No.1 People's Hospital,Jining 272011,China)

机构地区：[1]青岛大学附属医院麻醉科,266003 [2]济宁市第一人民医院麻醉科,272011 [3]济宁市第一人民医院胸外科,272011

出　　处：《国际麻醉学与复苏杂志》2020年第2期182-187,共6页International Journal of Anesthesiology and Resuscitation

基　　金：2017年济宁市科技助推新旧动能转换计划(2017SMNS0009)。

摘　　要：目的探讨双侧胸椎旁阻滞(bilateral thoracic paravertebral blocks,bTPVB)复合全身麻醉在胸腹腔镜联合食管癌根治术(thoracoscopic‐laparoscopic esophagectomy,TLE)中的应用及其对术后早期恢复的影响。方法采用随机数字表法将70例拟行TLE的食管癌患者分为全身麻醉组(G组)和bTPVB复合全身麻醉(B组),每组35例;5例患者因术中输血、改为传统开放手术等原因而排除,最终G组和B组分别纳入32例和33例患者。两组均采用标准的全身麻醉,B组在麻醉诱导前15 min行右侧T7‐T8、左侧T8‐T9的两点椎旁阻滞。记录两组患者围手术期血流动力学变化、麻醉时间、手术时间、术中麻醉药物及血管活性药物应用,记录PACU舒芬太尼和胸科ICU氟比洛芬酯补救镇痛药物的应用,记录睁眼时间、拔管时间、转入和转出PACU时镇静躁动评分、PACU停留时间、术后谵妄和术后48 h时肺功能,记录术后0、4、8、12、24、36、48 h静息和咳嗽时疼痛VAS评分和舒芬太尼累积用量。结果两组患者各时点血流动力学比较,差异无统计学意义(P>0.05)。与G组比较,B组术中舒芬太尼用量、PACU停留时间、术中硝酸甘油使用率、PACU舒芬太尼补救镇痛率、胸科ICU氟比洛芬酯补救镇痛率降低(P<0.05)。与术前比较,两组患者术后48 h时用力肺活量(forced vital capacity,FVC)及第1秒用力呼气容积(forced expiratory volume in one second,FEV1)降低(P<0.05),且G组低于B组(P<0.05)。G组术后0、4、8、12 h静息时和咳嗽时VAS评分均高于B组,且术后24 h时点咳嗽VAS评分亦高于B组(P<0.05)。B组术后4、8、12、24、36、48 h舒芬太尼累积用量均低于G组(P<0.05)。结论bTPVB复合全身麻醉用于TLE可减少围手术期镇痛药物用量,缓解术后早期疼痛,改善术后肺功能,从而促进术后早期康复。Objective To evaluate the application of bilateral thoracic paravertebral block(bTPVB)combined with general anesthesia in thoracoscopic‐laparoscopic esophagectomy(TLE)and its effects on early postoperative recovery.Methods Seventy patients with esophageal cancer scheduled for TLE were divided into two groups according to the random number table method(n=35):a general anesthesia group(group G)and a bTPVB combined with general anesthesia group(group B).Five patients were excluded due to intraoperative blood transfusion,traditional open surgery or other reasons.Finally,32 patients were included into group G and 33 patients in group B,respectively.Standardized general anesthesia was performed in both groups.Paravertebral blocks at the right T7?T8 level and the left T8?T9 level were performed 15 min before anesthesia induction in group B.Then,perioperative hemodynamics,the length of anesthesia and surgery,the use of anesthetics and vasoactive agents during operation in both groups were recorded.The use of sufentanil in the post‐anesthetic care unit(PACU)and flurbiprofen axetil in the thoracic intensive care unit(ICU)for rescue analgesia were recorded.The eye‐opening time,extubation time,sedation‐agitation scale scores of PACU admission and discharge,the length of PACU stay,postoperative delirium,and pulmonary function 48 h after surgery were recorded.The Visual Analogue Scale(VAS)scores at resting and upon coughing and the cumulative doses of sufentanil were assessed 0,4,8,12,24,36 h and 48 h after surgery.Re sults There was no statistical difference in hemodynamic parameters between the two groups at each time point(P>0.05).Compared with group G,the intraoperative doses of sufentanil,the length of PACU stay,the rate of intraoperative nitroglycerin use,and the rate of sufentanil use for rescue analgesia in PACU and the rate of flurbiprofen use for rescue analgesia in thoracic ICU significantly reduced in group B(P<0.05).Compared with pre‐operative levels,the forced vital capacity(FVC)and the forced expirator

关 键 词：椎旁阻滞 麻醉 全身 胸腔镜检查 腹腔镜检查 食管癌根治术 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]