超声引导下胸椎旁神经阻滞联合全麻手术对肺癌开胸手术患者应激反应、术后疼痛及镇痛的影响  

Effects of Ultrasound on Stress Response,Postoperative Pain and Analgesia in Patients Under Going Thoracic Surgery for TPVB Lung Cancer

作　　者：袁磊[1] 张汉湘[1] 周维纲[1] 黄柯冰 杨晓江 Yuan Lei;Zhang Hanxiang;Zhou Weigang(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong,Shanxi 723000,China)

机构地区：[1]汉中市中心医院麻醉科,陕西汉中723000 [2]陕西省城固县第二人民医院,陕西城固723200

出　　处：《四川医学》2020年第8期864-868,共5页Sichuan Medical Journal

摘　　要：目的探讨超声引导下胸椎旁神经阻滞(TPVB)联合全麻手术对肺癌开胸患者术后应激反应、术后疼痛及镇痛的影响。方法选取我院拟实施开胸手术治疗的肺癌患者100例,依据患者入院时间随机分配到联合组和对照组各50例,联合组采取全麻复合超声引导下TPVB麻醉、对照组采取全麻手术;记录并对比不同时间点的平均动脉压(MAP)、心率(HR)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、肾上腺素(E)、去甲肾上腺素(NE)、视觉模拟疼痛量表(VAS)评分及术后镇痛泵的使用情况。结果经过多因素方差分析,联合组和对照组的MAP、HR测定值在T0~T3时刻的波动情况比较,差异有统计学意义(P<0.05),对照组的MAP、HR测定值波动情况更加显著(P<0.05);术前联合组和对照组的血清Cor、AngⅡ、E、NE测定值比较,差异无统计学意义(P> 0.05);术后2 h,联合组的血清Cor、AngⅡ、E、NE测定值显著高于对照组(P<0.05);术后2 h、6 h、12 h、24 h及48 h,联合组的VAS评分均显著低于对照组(P<0.05);术后48 h,联合组舒芬太尼用量及镇痛泵按压次数均低于对照组(P<0.05)。结论肺癌开胸手术患者采用全麻复合超声下TPVB实施麻醉对于维持患者血流动力学稳定、减轻手术应激反应、降低术后镇痛泵按压次数及舒芬太尼用量具有一定的作用。Objective To investigate the effects of ultrasound-guided thoracic paravertebral nerve block( TPVB) combined with general anesthesia on postoperative stress response,postoperative pain and analgesiain patients with lung cancer and thoracotomy.Methods 100 patients with lung cancer who were planned to undergo thoracotomy in our hospital wereselected.According to the admission time,each 50 patientswere randomly assigned to the combined group and control group.The combined group underwent general anesthesia combined with ultrasound guided TPVB anesthesia,and the control group underwent general anesthesia.Mean arterial pressure( MAP),heart rate( HR),cortisol( Cor),angiotensin II( Ang II),adrenaline( E),norepinephrine( NE),visual simulated pain at different time points scale( VAS) scores and postoperative use of analgesic pumps were recorded and compared.Results After multivariate analysis of variance,MAP and HR of two groups at time of T0 ~ T3 were compared with statistically significant difference( P<0. 05).The fluctuation of MAP and HR in control group was more significant( P<0. 05).Before operation,serum Cor,Ang II,E and NE in combined group and control group were compared with no statistically significantdifference( P>0. 05).At 2 hours after operation,serum Cor,Ang II,E and NE of combined group were significantly higher than those of control group( P<0. 05).The VAS scores of combined group were significantly lower than those of control group at 2 h,6 h,12 h,24 h and 48 h after operation( P<0. 05).At 48 h after operation,the amount of sufentanil and the number of analgesic pumpcompressions in combined group were lower than those in control group( P < 0. 05). Conclusion Patients undergoing thoracotomy with lung cancer using TPVB under general anesthesia combined ultrasound have a certain effect on maintaining hemodynamic stability,reducing surgical stress response,reducing the number of postoperative analgesic pump compressions and the amount of sufentanil.

关 键 词：超声引导 胸椎旁神经阻滞 全身麻醉 应激反应 镇痛 

分 类 号：R614.2[医药卫生—麻醉学]