B超引导下胸椎旁神经阻滞在老年胸腔镜手术中的应用  

Application of B-ultrasound guided thoracic paravertebral nerve block in elderly thoracoscopic surgery

作　　者：陈夏华[1] 高元丽 孙世宇 陈美银[1] CHEN Xiahua;GAO Yuanli;SUN Shiyu(Department of Anesthesia,Maanshan People's Hospital,Maanshan 243000,China;Department of Anesthesiology,the Tenth People's Hospital of Tongji University)

机构地区：[1]马鞍山市人民医院麻醉科,安徽马鞍山243000 [2]同济大学附属上海市第十人民医院麻醉科

出　　处：《腹腔镜外科杂志》2024年第9期702-706,共5页Journal of Laparoscopic Surgery

基　　金：上海市卫生健康科研项目(20214Y0149)。

摘　　要：目的:观察B超引导下胸椎旁神经阻滞复合全身麻醉应用于老年胸腔镜手术中的效果。方法:选择2021年3月至2023年3月收治的92例行胸腔镜手术的老年患者,依据随机数字表法分为两组,每组46例,对照组采用全身麻醉,研究组采用B超引导下胸椎旁神经阻滞复合全身麻醉。比较两组镇痛效果、苏醒质量、应激反应指标、术后不良反应发生率。结果:术后6 h、12 h、24 h,研究组静息时、咳嗽时疼痛视觉模拟评分低于对照组(P<0.05)。研究组自主呼吸恢复时间、苏醒时间、拔管时间、首次下床活动时间短于对照组(P<0.05),镇静-躁动评分低于对照组。术后2 h,两组肾上腺皮质激素、去甲肾上腺素、8-异前列腺素F2α、血管紧张素Ⅱ均高于术前(P<0.05),且研究组低于对照组(P<0.05)。研究组术后不良反应总发生率低于对照组(P<0.05)。结论:B超引导下胸椎旁神经阻滞复合全身麻醉对老年胸腔镜手术患者的镇痛效果确切,可改善苏醒质量,减轻应激反应,减少术后不良反应。Objective:To observe the effect of B-ultrasound guided thoracic paravertebral nerve block(TPVB)combined with general anesthesia in elderly patients undergoing thoracoscopic surgery.Methods:From Mar.2021 to Mar.2023,92 elderly patients who underwent thoracoscopic surgery were collected and separated into two groups according to the random number table.The control group(n=46)was given general anesthesia,and the study group(n=46)was given B-ultrasound guided TPVB combined with general anesthesia.Analgesic effect,recovery quality,stress response indicators,and incidence of postoperative untoward reactions were compared between the two groups.Results:At 6 h,12 h,24 h after surgery,the study group had lower pain visual analogue scores at rest and during coughing compared to the control group(P<0.05).The spontaneous breathing recovery time,awakening time,extubation time,time of first ambulation,and sedation-agitation score of the study group were all shorter(or lower)than those of the control group(P<0.05).At 2 h after operation,the levels of adrenocortical hormone,norepinephrine,8-iso prostaglandin F2α,and angiotensinⅡin both groups were higher than those before operation(P<0.05),and those in the study group were lower than those in the control group(P<0.05).The total incidence of postoperative untoward reactions in the study group was lower than that in the control group(P<0.05).Conclusions:B-ultrasound guided TPVB combined with general anesthesia has a definite analgesic effect on elderly patients undergoing thoracoscopic surgery,which can improve the recovery quality,reduce stress reaction and postoperative untoward reactions.

关 键 词：麻醉 全身 胸椎旁神经阻滞 胸腔镜检查 超声检查 老年人 

分 类 号：R614[医药卫生—麻醉学]