椎旁神经阻滞联合目标导向液体治疗在开胸术中的应用研究  

Application of the therapy of paravertebral nerve block combined with target-oriented liquids in thoracotomy

作　　者：刘辉[1] 熊立红[1] 徐晓晴[1] 冯腾尘 王毅苗 高艳[1] LIU Hui;XIONG Lihong;XU Xiaoqing;FENG Tengchen;WANG Yimiao;GAO Yan(Department of Anesthesiology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院麻醉科,河北张家口075000

出　　处：《长春中医药大学学报》2023年第3期310-314,共5页Journal of Changchun University of Chinese Medicine

基　　金：河北省卫生健康委科研基金项目(20190909)。

摘　　要：目的探讨椎旁神经阻滞联合目标导向液体治疗应用于开胸术中的效果。方法选择拟行开胸手术的患者110例作为研究对象,按随机数表法分为对照组与观察组,各55例。对照组采用椎旁神经阻滞联合常规液体治疗,观察组采用椎旁神经阻滞联合目标导向液体治疗。比较2组手术指标(手术时间、术中出血量、术中总输液量、呼吸机辅助治疗时间、住院时间),并对比麻醉诱导前(T0)、麻醉诱导后(T1)、手术30 min(T2)、术毕(T3)时心率(HR)、平均静脉压(MAP)、D-乳酸及术前、术后1 d血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平,统计术后并发症发生情况。结果2组手术时间、术中出血量差异不显著(P>0.05);观察组术中总输液量小于对照组,呼吸机辅助治疗时间、住院时间短于对照组(P<0.05);HR、MAP在术中呈先降低后上升趋势,D-乳酸在术中呈先升高后降低趋势(P<0.05);T1、T2时观察组HR、MAP高于对照组,D-乳酸低于对照组(P<0.05);术后1 d 2组IL-6、TNF-α、CRP水平高于术前,术后1 d观察组IL-6、TNF-α、CRP水平低于对照组(P<0.05);观察组并发症总发生率为14.55%,对照组并发症总发生率为20.00%,组间比较差异无统计学意义(P>0.05)。结论椎旁神经阻滞联合目标导向液体治疗应用于开胸术中能减少术中总输液量,有助于术后恢复,维持术中血流动力学,减轻炎症反应发生,安全性高。Objective To study the effect of the therapy of paravertebral nerve block combined with target-oriented liquids in thoracotomy.Methods One hundred and ten patients scheduled for thoracotomy in our hospital from May 2018 to May 2020were selected as the research subjects.They were randomly divided into a control group and an observation group,with fiftyfive cases in each group.The control group was treated with the therapy of paravertebral nerve block combined with conventional liquids,while the observation group was treated with the therapy of paravertebral nerve block combined with target-oriented liquids.The operation indexes(operation time,intraoperative bleeding,total intraoperative infusion,ventilator-assisted treatment time and hospital stay)were compared between the two groups,and the heart rate(HR),mean arterial pressure(MAP),D-lactic acid before anesthesia induction(T0),after anesthesia induction(T1),30 minutes after operation(T2)and after operation(T3),the levels of the serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)before and on the first day after operation were compared in the two groups,and the incidence of postoperative complications was counted.Results There was no significant difference in the operation time and intraoperative bleeding between the two groups(P>0.05).The total intraoperative infusion in the observation group was less than that in the control group,and the time of ventilator assisted treatment and hospitalization in the observation group were shorter than those in the control group(P<0.05).During operation,HR and MAP decreased first and then increased,while D-lactic acid increased first and then decreased(P<0.05).At T1 and T2,HR and MAP in the observation group were higher than those in the control group,while D-lactic acid was lower than that in the control group(P<0.05).The levels of IL-6,TNF-αand CRP in both groups on the first day after operation were higher than that those before operation,while they were lower than those in the control gr

关 键 词：椎旁神经阻滞 目标导向液体 开胸手术 

分 类 号：R614[医药卫生—麻醉学]