腹腔镜根治术治疗胃癌时行椎旁神经阻滞的麻醉效果研究  

Study on the anesthetic effect of paravertebral nerve block during laparoscopic radical surgery for gastric cancer

作　　者：李显才 张桂文 姜义 LI Xian-cai;ZHANG Gui-wen;JIANG Yi(Department of Anesthesiology,Liaoning Health Industry Group Fuxin Mining General Hospital,Fuxin 123000,China)

机构地区：[1]辽宁省健康产业集团阜新市矿总医院麻醉科,123000

出　　处：《中国现代药物应用》2024年第1期14-18,共5页Chinese Journal of Modern Drug Application

摘　　要：目的 分析胃癌患者实施腹腔镜根治术时采取不同的麻醉方案对其麻醉效果及预后的影响。方法 50例行腹腔镜根治术治疗的胃癌患者,按入院诊疗先后顺序分为参考组与对照组,各25例。对照组行全身麻醉,参考组行全身麻醉+椎旁神经阻滞麻醉。比较两组患者的麻醉情况、手术不同时间段的血氧指标、插管前后的激素水平、不良反应发生情况、麻醉药用量、不同状态的疼痛评分。结果 对照组拔管时间为(25.58±1.42)min,麻醉后监测治疗室停留时间为(58.47±1.58)min;参考组拔管时间为(11.84±1.16)min,麻醉后监测治疗室停留时间为(41.82±1.14)min。参考组拔管时间、麻醉后监测治疗室停留时均短于对照组,差异有统计学意义(P<0.05)。手术15 min,参考组平均动脉压、心率分别为(85.26±1.71)mm Hg(1 mm Hg=0.133 kPa)、(55.85±1.35)次/min,低于对照组的(88.21±1.55)mm Hg、(60.79±0.55)次/min,差异有统计学意义(P<0.05)。术后,两组平均动脉压、心率比较,差异无统计学意义(P>0.05)。插管前,两组肾上腺素、去甲肾上腺素比较,差异无统计学意义(P>0.05);插管后即刻,参考组肾上腺素(72.64±1.25)pmol/L高于对照组的(59.54±1.53)pmol/L,去甲肾上腺素(264.45±0.39)pmol/L低于对照组的(278.77±0.54)pmol/L,差异有统计学意义(P<0.05)。参考组不良反应发生率为4.00%,低于对照组的28.00%,差异有统计学意义(P<0.05)。对照组丙泊酚用量(56±12)mg、瑞芬太尼用量(116±14)μg、舒芬太尼用量(130±12)μg;参考组丙泊酚用量(41±10)mg、瑞芬太尼用量(80±6)μg、舒芬太尼用量(94±10)μg。参考组丙泊酚用量、瑞芬太尼用量、舒芬太尼用量均低于对照组,差异有统计学意义(P<0.05)。插管后即刻,参考组静息状态及咳嗽状态的疼痛评分分别为(1.86±0.32)、(1.45±0.25)分,均低于对照组的(4.63±0.21)、(3.56±0.16)分,差异有统计学意义(P<0.05)。结论 在对胃癌患者行腹腔镜�Objective To analyze the impact of different anesthesia schemes on the anesthetic effect and prognosis of patients with laparoscopic radical surgery for gastric cancer.Methods A total of 50 patients with laparoscopic radical surgery for gastric cancer were divided into a reference group and a control group according to the order of admission and treatment,with 25 cases in each group.The control group received general anesthesia,and the reference group received general anesthesia+paravertebral nerve block anesthesia.Both groups were compared in terms of anesthesia,blood oxygen index in different time periods,hormone level before and after intubation,occurrence of adverse reactions,anesthetic dosage and pain score in different states.Results The extubation time in the control group was(25.58±1.42)min,and the duration of stay in monitoring treatment room after anesthesia was(58.47±1.58)min;the extubation time in the reference group was(11.84±1.16)min,and the stay time in the monitoring treatment room after anesthesia was(41.82±1.14)min.The extubation time and the stay time in the monitoring treatment room after anesthesia in the reference group were shorter than those in the control group,and the differences were statistically significant(P<0.05).After 15 min of surgery,the mean arterial pressure and heart rate in the reference group were(85.26±1.71)mm Hg(1 mm Hg=0.133 kPa)and(55.85±1.35)beats/min,which were lower than those of(88.21±1.55)mm Hg and(60.79±0.55)beats/min in the control group,respectively.The difference was statistically significant(P<0.05).After surgery,there was no statistically significant difference in mean arterial pressure and heart rate between the two groups(P>0.05).Before intubation,there was no statistically significant difference in epinephrine and norepinephrine between the two groups(P>0.05).Immediately after intubation,the epinephrine of(72.64±1.25)pmol/L in the reference group was higher than that of(59.54±1.53)pmol/L in the control group,and the norepinephrine of(264.45±0.39)

关 键 词：椎旁神经阻滞 腹腔镜根治术 胃癌 麻醉效果 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]