胸椎旁神经阻滞复合全身麻醉在老年开胸手术患者中的应用效果观察  

Observation on the application effect of thoracic paravertebral nerve block combined with general anesthesia in elderly patients undergoing thoracotomy

作　　者：朱梅 范天琼 ZHU Mei;FAN Tianqiong(Department of Anesthesiology,Chest Hospital of Jingzhou City in Hubei Province,Hubei,Jingzhou 434000,China)

机构地区：[1]湖北省荆州市胸科医院麻醉科,湖北荆州434000

出　　处：《中国医药科学》2021年第7期180-183,共4页China Medicine And Pharmacy

摘　　要：目的观察胸椎旁神经阻滞复合全身麻醉在老年开胸手术患者中的应用效果。方法选择荆州市胸科医院2017年2月至2019年10月期间行开胸手术治疗的68例老年患者作为研究对象,根据麻醉方式不同分为两组,每组各34例。对照组仅采取全身麻醉,观察组采取超声引导下胸椎旁神经阻滞复合全身麻醉。比较两组患者麻醉效果,比较两组患者在麻醉前(T0)、麻醉后(T1)、术中组织牵拉时(T2)、术后缝皮时(T3)等时间点每搏量变异度(SVV)、每搏量(SV)、心率和平均动脉压等心功能指标,同时还比较两组患者肺不张、肺部感染和低氧血症等术后并发症发生率。结果观察组患者麻醉优良率(88.24%)高于对照组(64.71%),差异有统计学意义(P<0.05);两组患者T0时SVV、SV、心率、平均动脉压等指标比较差异无统计学意义(P>0.05),观察组患者在T1、T2、T3时SV、心率、平均动脉压等指标均低于对照组,而SVV均高于对照组,差异有统计学意义(P<0.05);观察组患者术后并发症发生率(11.76%)低于对照组(26.47%),差异有统计学意义(P<0.05)。结论老年开胸手术患者应用胸椎旁神经阻滞复合全身麻醉效果显著,不但对心功能影响较少,且术后并发症发生率也明显降低。Objective To observe the application effect of thoracic paravertebral nerve block combined with general anesthesia in elderly patients undergoing thoracotomy.Methods A total of 68 elderly patients undergoing thoracotomy admitted to Chest Hospital of Jingzhou City from February 2017 to October 2019 were selected as the research objects.According to different anesthesia methods,they were divided into the control group(n=34)and the observation group(n=34).The control group was only treated with general anesthesia,while the observation group was treated with ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.The anesthetic effects of the two groups were compared,and the cardiac function indexes such as the variability of stroke volume(SVV),stroke volume(SV),heart rate(HR)and mean arterial pressure(MAP)were compared at the time points as before anesthesia(T0),after anesthesia(T1),tissue traction during operation(T2)and skin suture after operation(T3).The incidence of postoperative complications such as atelectasis,pulmonary infection and hypoxemia were also compared simultaneously between patients of the two groups.Results The excellent and good rate of anesthesia in the observation group was 88.24%,which was higher than 64.71%in the control group,with statistically significant difference(P<0.05).There were no statistically significant differences in SVV,SV,HR and MAP between the two groups at T0(P>0.05).However,the SV,HR,MAP and other indexes of patients in the observation group at T1,T2 and T3 were lower than those in the control group,while SVV were all higher than those of the control group,with statistically significant differences(P<0.05).The incidence of postoperative complications in patients of the observation group was 11.76%,which was significantly lower than 26.47%of the control group,with statistically significant difference(P<0.05).Conclusion The effect of thoracic paravertebral nerve block combined with general anesthesia in elderly patients undergoing thoracotomy is r

关 键 词：胸椎旁神经阻滞 全身麻醉 开胸手术 心功能 

分 类 号：R614[医药卫生—麻醉学]