胸椎旁神经阻滞联合支气管阻塞导管在胸腔镜手术中的应用  

Application of thoracic paravertebral block combined with bronchial blocker placement in thoracoscopic surgery

作　　者：蔡东妙[1] 王庆祥[1] 汪海松[1] 林绍立[1] 许智鸿 Cai Dongmiao;Wang Qingxiang;Wang Haisong;Lin Shaoli;Xu Zhihong(Department of Anesthesiology,The First Affiliated Hospital of Xiamen University(Xiamen Anesthesia Medical Quality Control Center),Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院麻醉手术科(厦门市麻醉医疗质量控制中心),厦门361000

出　　处：《中国基层医药》2024年第11期1666-1671,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨超声引导下胸椎旁神经阻滞(TPVB)联合支气管阻塞导管(BB)在胸腔镜手术中的临床应用价值。方法采用随机对照研究,选取2023年11—12月厦门大学附属第一医院择期行胸腔镜手术、美国麻醉医师协会分级(ASA)Ⅰ~Ⅱ级患者60例,根据随机数字表法分为观察组(BB,T组)和对照组(双腔支气管,C组),每组30例。术前均在超声引导下完善TPVB。全身麻醉诱导后,T组插入单腔气管导管后,再置入BB;C组插入相应型号双腔支气管导管,两组均使用纤维支气管镜对位并固定,全凭静脉维持麻醉。观察两组插管定位时间、移位例数、术后咽痛例数、插管前后血流动力学[平均动脉压(MAP)和心率(HR)]、血气分析[氧分压(PaO_(2))和二氧化碳分压(PaCO_(2))]变化;记录术野暴露程度评分;术中丙泊酚、瑞芬太尼用量和苏醒时间;比较两组炎症因子[白细胞介素(IL)2、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF)α、TNF-β]相关指标和术后2 h、4 h、8 h、10 h、12 h、24 h时的静息和咳嗽视觉模拟评分法(VAS)评分。结果T组术中丙泊酚[(569.7±29.2)mg]和瑞芬太尼[(289.3±46.3)μg]总量均少于C组[(612.6±28.7)mg、(361.7±40.6)μg](t=5.74、6.44,P=0.001、0.001);T组苏醒时间[(31.8±11.4)min]短于C组[(37.5±10.1)min](t=2.10,P=0.040)。T组插管定位时间[(67±13)s]与C组[(80±36)s]比较差异无统计学意义(t=1.86,P=0.068);T组插管后移位百分率[23.3%(7/30)]与C组[16.7%(5/30)]比较差异无统计学意义(χ^(2)=0.58,P=0.445)。T组术后咽痛发生率[10.0%(3/30)]低于C组[33.3%(10/30)](χ^(2)=5.02,P=0.025)。两组移位比例、血流动力学指标、血气分析、炎症指标、术野暴露程度、术后VAS评分等差异均无统计学意义(均P>0.05)。结论超声引导下TPVB联合BB在胸腔镜手术中相比双腔支气管导管可减少气道损伤,术中镇静、镇痛充分,苏醒迅速,自主呼吸恢复早,不良反应较少,值得临床推广。Objective To investigate the clinical value of ultrasound-guided thoracic paravertebral block(TPVB)combined with bronchial blocker(BB)placement in thoracoscopic surgery.MethodsA randomized controlled study was conducted involving 60 patients scheduled for thoracoscopic surgery at The First Affiliated Hospital of Xiamen University from November to December 2023.These patients were classified as American Society of Anesthesiologists(ASA)I-II.They were divided into an observation group(BB placement)and a control group(double-lumen bronchial blocker placement)using the random number table method,with 30 patients in each group.Preoperatively,TPVB was performed under ultrasound guidance.After the induction of general anesthesia,a single-lumen tracheal tube was inserted,followed by the placement of a BB in the observation group,while a corresponding type of double-lumen bronchial tube was inserted in the control group.A fiberoptic bronchoscope was used for positioning and fixation in both groups,and anesthesia was maintained with intravenous anesthesia.The following parameters were assessed in each group:positioning time for intubation;number of cases with tube displacement;number of cases of postoperative pharyngeal pain;hemodynamic parameters[mean arterial pressure(MAP)and heart rate(HR)]before and after intubation;and blood gas analysis[partial pressure of oxygen(PaO_(2))and carbon dioxide(PaCO_(2))].Additionally,the surgical field exposure score and the dosages of propofol and remifentanil administered during surgery were recorded.Levels of inflammatory markers[interleukin(IL)-2,IL-4,IL-6,IL-10,tumor necrosis factor(TNF)-α,and TNF-β]and Visual Analog Scale scores for pain at rest and during cough,recorded at 2,4,8,10,12,and 24 hours postoperatively were compared between the two groups.Results The total amounts of propofol[(569.7±29.2)mg]and remifentanil[(289.3±46.3)μg]in the observation group were significantly lower than those in the control group[(612.6±28.7)mg,(361.7±40.6)μg,t=5.74,6.44,both P=0.001].The

关 键 词：胸腔镜检查 支气管 神经传导阻滞 超声检查 康复 镇痛 炎症介导素类 血流动力学 

分 类 号：R614[医药卫生—麻醉学]