超声引导下TPVB与RSB对食管癌根治术中血流动力学及术后急性疼痛的影响  

Effects of ultrasound-guided TPVB and RSB on hemodynamics and postoperative acute pain in patients undergoing radical esophageal cancer surgery

作　　者：汪大彬 阎文军[1] 朱磊 胡琼花 郝爽 WANG Dabin;YAN Wenjun;ZHU Lei;HU Qionghua;HAO Shuang(Department of Anesthesiology,Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院麻醉科,甘肃兰州730000

出　　处：《麻醉安全与质控》2021年第6期368-372,共5页Perioperative Safety and Quality Assurance

基　　金：国家自然科学基金(81860233)。

摘　　要：目的探讨超声引导下胸椎旁神经阻滞(TPVB)联合腹直肌鞘神经阻滞(RSB)应用于胸腹联合切口下食管癌根治术患者术中血流动力学以及术后急性疼痛的效果。方法选取2018-03/2020-03期间甘肃省人民医院拟择期行胸腹联合食管癌根治术患者40例作为研究对象,ASA分级Ⅰ~Ⅲ级,随机分为胸椎旁联合腹直肌鞘神经阻滞+全身麻醉组(N组,n=20)和全身麻醉组(G组,n=20)。N组全麻诱导前行超声引导下TPVB和RSB,2组术后均给予患者自控静脉镇痛(PCIA);记录2组患者诱导前(T_(1))、切皮前(T_(2))、切皮后1 min(T_(3))、关胸时(T_(4))、手术结束时(T_(5))、拔管后30 min(T_(6))时的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏量(SV)、每搏量变异度(SVV);术后2 h、4 h、8 h、12 h、18 h、24 h的静息和咳嗽时视觉模拟评分(VAS);术中瑞芬太尼用量以及术后24 h舒芬太尼用量以及患者自控镇痛(PCA)按压次数。结果与G组比较,N组在手术刺激较强的T_(3)、T_(4)时间点血流动力学更为平稳(P<0.05),术中瑞芬太尼使用量更低(P<0.05),术后12 h内静息和咳嗽VAS镇痛评分低(P<0.05),术后24 h舒芬太尼消耗量、PCIA按压次数少(P<0.05)。结论超声引导下TPVB联合RSB应用于胸腹联合切口下食管癌根治术患者,能够有效的管理术中以及术后的疼痛,术中血流动力学稳定,安全性高。Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block(TPVB)combined with rectus sheath nerve block(RSB)on intraoperative hemodynamics and acute postoperative pain in patients undergoing radical esophageal cancer surgery.Methods Forty patients,ASA Ⅰ-Ⅲ,who underwent elective combined thoracoabdominal radical esophageal cancer surgery,in Gansu Provincial Hospital from March 2018 to March 2020,were randomly divided into thoracic paravertebral combined with rectus sheath nerve block+general anesthesia group(group N,n=20)and general anesthesia group(group G,n=20).Group N received ultrasound guided TPVB and RSB before induction of general anesthesia.Both groups received patient-controlled intravenous analgesia(PCIA)after operation.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume(SV)and stroke volume variability(SVV)were recorded before induction(T_(1)),before skin incision(T_(2)),1 min after skin incision(T_(3)),at chest closure(T_(4)),at the end of operation(T_(5))and half an hour after extubation(T_(6)).The postoperative VAS scores for resting and coughing(at 2 h,4 h,8 h,12 h,18 h,24 h postoperatively),intraoperative remifentanil dosage,postoperative 24 h sufentanil dosage and PCIA usage times were recorded.Results Compared with group G,group N had smoother hemodynamics at T_(3) and T_(4)(P<0.05),lower intraoperative remifentanil use(P<0.05),lower resting and cough VAS analgesia scores at 12 h postoperatively(P<0.05),and less sufentanil consumption and number of PCIA presses at 24 h postoperatively(P<0.05).Conclusion For patients undergoing radical esphageal cancer surgery,ultrasound-guided TPVB combined with RSB can effectively manage intraoperative as well as postoperative pain with stable intraoperative hemodynamics and high safety.

关 键 词：胸椎旁神经阻滞 腹直肌鞘神经阻滞 食管癌根治术 血流动力学 术后镇痛 

分 类 号：R735.1[医药卫生—肿瘤] R614[医药卫生—临床医学]