胸椎旁神经阻滞对剖胸手术患者应激激素水平的影响  

Effect of thoracic paravertebral nerve block on stress hormone level in patients undergoing thoracotomy

作　　者：高宁宁 杨明月 樊腾[1] 李晓芳[1] 张红伟[1] 胡淋淋 张文杰 张杰[1] 徐璐丹 岳修勤[1] GAO Ningning;YANG Mingyue;FAN Teng;LI Xiaofang;ZHANG Hongwei;HU Linlin;ZHANG Wenjie;ZHANG Jie;XU Ludan;YUE Xiuqin(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院麻醉科,河南卫辉453100

出　　处：《新乡医学院学报》2020年第3期235-238,共4页Journal of Xinxiang Medical University

基　　金：国家自然科学基金面上项目(编号:8870926);河南省医学科技攻关计划省部共建项目(编号:SBGJ2018054);河南省卫生科技创新型人才工程中青年科技创新人才资助项目(编号:20114155)。

摘　　要：目的探讨椎旁神经阻滞对剖胸手术患者应激激素水平的影响。方法选择2018年8月至2019年8月新乡医学院第一附属医院收治的54例行剖胸手术的食管癌患者为研究对象,按照手术单双日分组,单日手术者为对照组(n=28),双日手术者为观察组(n=26)。对照组患者采用双腔支气管插管全身麻醉;观察组患者采用单侧胸椎旁神经阻滞后双腔支气管插管全身麻醉。2组患者麻醉诱导用药相同,术中采用静脉-吸入复合麻醉维持。分别于麻醉诱导前(观察组在椎旁神经阻滞前)(T1)、气管插管时(T2),手术1 h(T3)、手术2 h(T4)、术毕(T5)抽取外周静脉血5 mL,检测血清去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、皮质醇(COR)水平;记录2组患者T1、T2、T3、T4、T5时的平均动脉压(MAP)和心率(HR)。结果2组患者T1时血清NE、ACTH、COR水平及MAP、HR比较差异均无统计学意义(P>0.05)。2组患者T2、T3、T4、T5时血清NE、ACTH、COR水平较T1时显著升高(P<0.05);2组患者T2、T3、T4时血清NE、ACTH、COR水平较T5时显著降低(P<0.05);观察组患者T2、T3、T4、T5时血清NE、ACTH、COR水平均显著低于对照组(P<0.05)。对照组患者T2、T3、T4时MAP显著低于T1(P<0.05);观察组患者T2、T3、T4、T5时MAP显著低于T1(P<0.05);观察组患者T2、T3、T4、T5时MAP显著低于对照组(P<0.05)。对照组患者T2、T5时HR显著高于T1(P<0.05);观察组患者T2时HR显著高于T1(P<0.05);2组患者T3、T4、T5时HR低于T2时(P<0.05);观察组患者T2、T5时HR显著低于对照组(P<0.05)。结论胸椎旁神经阻滞能减轻剖胸手术的应激反应,抑制NE、COR和ACTH的分泌,维持循环系统稳定。Objective To investigate the effect of thoracic paravertebral nerve block on the stress hormone level in patients undergoing thoracotomy.Methods Fifty-four patients with esophageal cancer who underwent thoracotomy in the First Affiliated Hospital of Xinxiang Medical University from August 2018 to August 2019 were selected as the study subjects.The patients were grouped by according to single or dual day of operation,the patients who were given operation on the single day were enrolled in the control group(n=28),and the patients who were given operation on the dual day were enrolled in the observation group(n=26).The patients in the control group were given general anesthesia by double lumen endotracheal intubation,while the patients in the observation group were given general anesthesia by double lumen endotracheal intubation after unilateral thoracic paravertebral nerve block.The general anesthesia induction medication was same in both groups,and it was maintained by combined intravenous and inhalation anesthesia.5 mL peripheral veins were collected at the time points of before induction of anesthesia(before paravertebral nerve block in the observation group)(T1),tracheal intubation(T2),1 hour(T3)and 2 hours(T4)after operation,and the end of the operation(T5),respectively.The levels of serum norepinephrine(NE),adrenocorticotropic hormone(ACTH)and cortisol(COR)were detected.The mean arterial pressure(MAP)and heart rate(HR)of patients in the two groups were recorded at the time points of T1,T2,T3,T4 and T5.Results There was no significant difference in the levels of serum NE,ACTH,COR and MAP,HR at T1 between the two groups(P>0.05).The levels of serum NE,ACTH and COR at T2,T3,T4 and T5 were significantly higher than those at T1 in the two groups(P<0.05).The levels of NE,ACTH and COR at T2,T3,T4 were significantly lower than those at T5 in the two groups(P<0.05).The levels of serum NE,ACTH and COR in the observation group were significantly lower than those in the control group at T2,T3,T4 and T5(P<0.05).The MAP at

关 键 词：椎旁神经阻滞 剖胸手术 应激激素 应激反应 

分 类 号：R614[医药卫生—麻醉学]