超声引导椎旁神经阻滞复合气管插管全麻在妇科肿瘤根治术中的应用效果  

Application Effect of Ultrasound-guided Paravertebral Nerve Block Compound Tracheal Intubation of General Anesthesia in Gynecological Radical Tumor Resection

作　　者：赖少娟 曹华娜 王柳莺 LAI Shaojuan;CAO Huana;WANG Liuying(Guangzhou Panyu Maternal and Child Health Hospital,Guangzhou 511400,China;不详)

机构地区：[1]广州市番禺区妇幼保健院,广东广州511400

出　　处：《中外医学研究》2023年第8期17-22,共6页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：番禺区科技计划项目(2021-Z04-041)。

摘　　要：目的:探讨超声引导椎旁神经阻滞复合气管插管全麻在妇科肿瘤根治术中的应用效果。方法:通过随机抽样法,选取2021年1月—2022年3月100例于广州市番禺区妇幼保健院进行妇科肿瘤开腹根治术患者作为研究对象,以随机数表法分为两组,每组各50例。对照组行气管插管全麻,观察组行超声引导椎旁神经阻滞复合气管插管全麻。比较两组手术开始前(T_(0))、手术开始后5 min(T_(1))、进行探查时(T_(2))、手术开始后20 min(T_(3))、手术结束后12 h(T_(4))、手术结束后24 h(T_(5))的平均动脉压(MAP)、心率(HR),术后12 h、24 h、48 h视觉模拟量表(VAS)及Nrf2-Keap1-ARE信号通路相关的Nrf2蛋白、Keap1蛋白、ARE蛋白、丙二醛(MDA)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)等指标水平,术中镇痛药物用量。结果:两组T_(1)~T_(5)时MAP、HR均高于T_(0)时,差异均有统计学意义(P<0.05);但观察组T_(1)~T_(4)时MAP、HR均低于对照组,差异均有统计学意义(P<0.05)。两组术后24 h、48 h外周血Nrf2蛋白、Keap1蛋白、ARE蛋白、血清SOD、CAT水平及VAS评分均低于术后12 h,血清MDA水平均高于术后12 h,差异均有统计学意义(P<0.05);但观察组术后12 h、24 h、48 h外周血Nrf2蛋白、Keap1蛋白、ARE蛋白、血清SOD、CAT水平均高于对照组,血清MDA水平、VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组术中丙泊酚、舒芬太尼用量明显低于对照组,差异均有统计学意义(P<0.05)。结论:超声引导椎旁神经阻滞复合气管插管全麻可稳定围手术期血流动力学,改善妇科肿瘤开腹根治术中Nrf2-Keap1-ARE信号通路相关因子,减轻氧化应激反应,减少手术过程中全麻药物使用量,降低术后疼痛感。Objective:To investigate the application effect of ultrasound-guided paravertebral nerve block compound tracheal intubation general anesthesia in gynecological radical tumor resection.Method:Through random sampling method,100 patients who underwent radical gynecological surgery in Guangzhou Panyu Maternal and Child Health Hospital from January 2021 to March 2022 were selected as the research objects,they were divided into two groups by random number table method,50 cases in each group.The control group was given general anesthesia with endotracheal intubation,and the observation group was given ultrasound-guided paravertebral nerve block compound tracheal intubation general anesthesia.The mean arterial pressure(MAP)and heart rate(HR)of two groups were compared before operation(T_(0)),5 min after operation(T_(1)),at the time of exploration(T_(2)),20 min after operation(T_(3)),12 h after operation(T_(4)),and 24 h after operation(T_(5)),visual analog scale(VAS)and nuclear factor erythroid 2 related factor 2(Nrf2)-Kelch-like ECHassociated protein 1(Keap1)-antioxidant response element(ARE)signaling pathway such as Nrf2 protein,Keap1 protein,ARE protein,malondialdehyde(MDA),catalase(CAT),superoxide dismutase(SOD)and other correlated indexes levels at 12 h,24 h and 48 h after operation were compared between two group.The dosage of intraoperative analgesic drugs were compared in two groups.Result:The MAP and HR of two groups at T_(1)-T_(5)were higher than those at T_(0),and the differences were statistically significant(P<0.05);however,the MAP and HR in the observation group at T_(1)-T_(4)were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of Nrf2 protein,Keap1 protein,ARE protein in peripheral blood,serum SOD,CAT and VAS score of two groups at 24 and 48 h after operation were lower than those at 12 h after operation,and the serum MDA levels were higher than those at 12 h after operation,the differences were statistically significant(P<0.05);but the levels of N

关 键 词：妇科肿瘤开腹根治术 椎旁神经阻滞 Nrf2-Keap1-ARE信号通路 氧化应激 术后镇痛 

分 类 号：R614.2[医药卫生—麻醉学] R737.3[医药卫生—外科学]