超声引导胸椎旁神经阻滞复合全身麻醉在开胸手术中的应用  

Application of ultrasound-guided paravertebral nerve block combined with general anesthesia in thoracotomy

作　　者：刘辉[1] 熊立红[1] 徐晓晴[1] 冯腾尘 王毅苗 高艳[1] 王丽[1] 滕金亮[1] LIU Hui;XIONG Li-hong;XU Xiao-qing;FENG Teng-chen;WANG Yi-miao;GAO Yan;WANG Li;TENG Jin-liang(Department of Anesthesia,First Affiliated Hosptial of Hebei North University,Zhangjiakou Hebei 075000,China;Department of Intensive Care Medicine,First Affiliated Hosptial of Hebei North University,Zhangjiakou Hebei 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 [2]河北北方学院附属第一医院重症医学科,河北张家口075000

出　　处：《局解手术学杂志》2023年第7期621-624,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省卫生健康委科研基金项目(20190909)。

摘　　要：目的探讨超声引导胸椎旁神经阻滞复合全身麻醉在开胸手术中的应用效果。方法选取2018年5月至2020年5月本院收治的择期行开胸手术患者60例,随机将其分为观察组30例(给予超声引导胸椎旁神经阻滞复合全身麻醉)和对照组30例(给予单纯全身麻醉)。记录并比较2组患者不同时间点心率、平均动脉压(MAP)、VAS评分及氧化应激反应指标[去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、超氧化物歧化酶(SOD)、丙二醛(MDA)],比较2组术后不良反应发生情况。结果观察组术后2 h、6 h、12 h、24 h心率及MAP均显著低于对照组(P<0.05)。2组术后2 h、6 h、12 h、24 h的VAS评分逐渐降低(P<0.05),而观察组术后VAS评分均显著低于对照组(P<0.05)。2组术后24 h血清NE、ACTH、Cor及MDA水平均显著升高(P<0.05),而SOD水平显著降低(P<0.05);观察组患者术后24 h血清NE、ACTH、Cor、SOD及MDA水平均显著低于对照组(P<0.05)。观察组术后不良反应总发生率明显低于对照组(P<0.05)。结论超声引导胸椎旁神经阻滞复合全身麻醉对行开胸手术患者的心率、MAP影响较小,能明显减轻患者术后疼痛及氧化应激反应,安全性较高。Objective To explore the application effect of ultrasound-guided paravertebral nerve block combined with general anesthe-sia for patients undergoing thoracotomy.Methods A total of 60 patients underwent elective thoracotomy in our hosipital form May 2018 to May 2020 were selected,then randomly divided into the observation group 30 cases(given ultrasound-guided paravertebral nerve block com-bined with general anesthesia)and the control group 30 cases(only given general anesthesia).The heart rate,mean arterial pressure(MAP),VAS score and the indexes of oxidative stress response[noradrenaline(NE),adrenocorticotrophic hormone(ACTH),cortisol(Cor),superox-ide dismutase(SOD),malondialdehyde(MDA)]at different time points were recorded and compared.The postoperative adverse reactions of the two groups were compared.Results The heart rate and the MAP at 2 hours,6 hours,12 hours and 24 hours after surgery of the observa-tion group were significantly lower than those of the control group(P<0.05).The VAS scores of the two groups gradualy decreased from 2 hours to 24 hours after operation,the VAS scores at different time points after surgery of the observation group were all significantly lower than those of the control group(P<0.05).The serum NE,ACTH,Cor and MDA levels at 24 hours after surgery of the two groups increased significantly(P<0.05),while the serum SOD levels decreased significantly(P<0.05);The serum NE,ACTH,Cor,SOD and MDA levels at 24 hours of the patients in the observation group were significantly lower than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Ultrasound-guided paravertebral nerve block combined with general anesthesia has little effect on heart rate and MAP of patients underwent thoracotomy,which can significantly relieve the postoperative pain and oxidative stress,with high safety.

关 键 词：超声 胸椎旁神经阻滞 全身麻醉 开胸手术 

分 类 号：R614.2[医药卫生—麻醉学]