椎旁神经阻滞联合全身麻醉对胸腔镜肺叶切除术老年患者术中局部脑氧饱和度的影响  

Effect of paravertebral nerve block combined with general anesthesia on intraoperative regional cerebral oxygen saturation in elderly patients undergoing thoracoscopic lobectomy

作　　者：赵伟[1] 李超[1] 王之骄 申军梅[1] 贾慧群[1] Zhao Wei;Li Chao;Wang Zhijiao;Shen Junmei;Jia Huiqun(Department of Anesthesiology,Forth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院麻醉科,石家庄050011

出　　处：《中华麻醉学杂志》2021年第8期939-942,共4页Chinese Journal of Anesthesiology

基　　金：河北省医学科学研究重点课题(20190709)。

摘　　要：目的评价椎旁神经阻滞(PVNB)联合全身麻醉对胸腔镜肺叶切除术老年患者术中局部脑氧饱和度(rScO_(2))的影响。方法择期拟行胸腔镜肺叶切除术患者70例,性别不限,年龄60~85岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=35):全身麻醉组(G组)和PVNB联合全身麻醉组(PG组)。PG组于麻醉诱导前实施超声引导下患侧T_(4)和T6两点PVNB,各注入0.5%罗哌卡因10 ml。麻醉诱导后,静脉泵注丙泊酚和瑞芬太尼麻醉维持,术毕连接PCIA。记录rScO_(2)最大值、最小值和累积低于基础值时间。于麻醉前(T_(0))、单肺通气前5 min(T_(1))、单肺通气后5 min(T_(2))和气管拔管(T_(3))时记录rScO_(2);记录术后住院时间和术后30 d内有关并发症发生的情况。结果与G组比较,PG组患者术中rScO_(2)最小值、T_(2)和T_(3)时rScO_(2)升高,术后认知功能障碍发生率降低(P<0.05),其他指标差异无统计学意义(P>0.05)。结论PVNB联合全身麻醉可改善胸腔镜肺叶切除术老年患者术中rScO_(2),减少术后认知功能障碍的发生。Objective To evaluate the effect of paravertebral nerve block(PVNB)combined with general anesthesia on intraoperative regional cerebral oxygen saturation(rScO_(2))in elderly patients undergoing thoracoscopic lobectomy.Methods Seventy American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes,aged 60-85 yr,with body mass index of 18-25 kg/m^(2),were divided into 2 groups(n=35 each)using a random number table method:general anesthesia group(group G)and PVNB combined with general anesthesia group(group PG).PVNB was performed at T_(4)and T6 with 0.5%ropivocaine 10 ml for each site under ultrasound guidance before induction of anesthesia in group PG.After induction of anesthesia,anesthesia was maintained with IV propofol and remifentanil,and a patient-controlled intravenous analgesia pump was connected at the end of operation.The maximum and minimum rScO_(2)and cumulative time of rScO_(2)below the baseline value were recorded.The rScO_(2)was recorded before anesthesia(T_(0)),at 5 min before one-lung ventilation(T_(1)),at 5 min after one-lung ventilation(T_(2))and at tracheal extubation(T_(3)).The length of postoperative hospital stay and complications within 30 days after operation were recorded.Results Compared with group G,the minimum rScO_(2)and rScO_(2)at T_(2)and T_(3)were significantly increased,the incidence of postoperative cognitive dysfunction was reduced(P<0.05),and no significant change was found in the other parameters mentioned above in group PG(P>0.05).Conclusion PVNB combined with general anesthesia can improve intraoperative rScO_(2)and reduce the development of postoperative cognitive dysfunction in elderly patients undergoing thoracoscopic lobectomy.

关 键 词：神经传导阻滞 胸椎 麻醉 全身 胸腔镜检查 肺切除术 老年人 脑 氧 

分 类 号：R614[医药卫生—麻醉学]