TPVB麻醉镇痛对腹腔镜肾切除术患者围手术期血流动力学与苏醒质量的影响  

Effect of TPVB as anesthesia and analgesia on perioperative hemodynamics and recovery quality in patients undergoing laparoscopic nephrectomy

作　　者：岳芳 段万里[2] 程继[2] 陈方[1] 付国 YUE Fang;DUAN Wanli;CHENG Ji;CHEN Fang;FU Guo(Department of Anesthesiology,Shanxi Provincial People's Hospital,Xi'an 710068,China;Department of Urology,Shanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院麻醉科,陕西西安710068 [2]陕西省人民医院泌尿外科,陕西西安710068

出　　处：《西部医学》2025年第3期377-381,共5页Medical Journal of West China

基　　金：陕西省自然科学基础研究计划项目(2020JQ-945)。

摘　　要：目的探讨连续胸椎旁神经阻滞(TPVB)麻醉镇痛对腹腔镜肾切除术患者围手术期血流动力学、苏醒质量的影响。方法回顾性分析2018年2月—2021年6月我院收治的98例行腹腔镜肾切除术患者的临床资料,将其分为对照组与观察组,每组49例。对照组采用全身麻醉,观察组在对照组基础上联合连续TPVB麻醉镇痛。比较两组手术相关指标、不同时间点(T0:进入手术室时;T1:麻醉诱导3 min后;T2:手术开始时;T3:手术结束时;T4:出手术室时)的围术期血流动力学指标、苏醒质量、疼痛程度以及不良反应。结果两组手术相关指标(手术时间、术中出血量、切口长度、术中尿量)比较未见显著差异(P>0.05);两组平均动脉压(MAP)、血氧饱和度时间、组间、交互效应比较,差异有统计学意义(P<0.05);两组T1~T4时MAP比较,差异有统计学意义(P<0.05),两组T0时MAP及T0~T4时心率(HR)、血氧饱和度比较未见显著差异(P>0.05);观察组Ramsay镇静评分、Steward苏醒评分高于对照组(P<0.05);两组苏醒期躁动分级比较,差异有统计学意义(P<0.05);两组静息时与运动时的视觉模拟评分(VAS)时间、组间、交互效应比较,差异显著(P<0.05);观察组术后12、24 h时的静息与运动时VAS均低于对照组(P<0.05),两组6、48 h时的VAS评分比较,差异无统计学意义(P>0.05);两组术后不良反应(呼吸抑制、恶心呕吐、瘙痒、寒战、镇痛不足)总发生率比较,差异无统计学意义(P>0.05)。结论采用连续TPVB麻醉镇痛对腹腔镜肾切除术患者进行干预,可显著改善患者围术期血流动力学、提升苏醒质量、缓解疼痛,同时不会增加不良反应发生率,可以用于临床推广。Objective To investigate the effect of continuous thoracic paravertebral nerve block(TPVB)as anesthesia and analgesia on perioperative hemodynamics and recovery quality in patients undergoing laparoscopic nephrectomy.Methods The clinical data of 98 patients who underwent laparoscopic nephrectomy in the hospital from February 2018 to June 2021 were analyzed retrospectively.Patients undergoing general anesthesia and those undergoing continuous TPVB were included in the control group(n=49)and the observation group(n=49),respectively.Operation related indicators,perioperative hemodynamic indexes at different time points[when entering the operating room(T0),after 3 minutes of anesthesia induction(T1),at the beginning of operation(T2),at the end of operation(T3),when leaving the operating room(T4)],recovery quality,pain degree,and adverse reactions were compared between groups.Results The operation-related indicators in the two groups were similar(P>0.05).There were statistically significant differences in mean arterial pressure(MAP)and blood oxygen saturation in terms of time effect,inter-group effect and interaction effect(P<0.05).The two groups had significantly different MAP at T1-T4(P<0.05).MAP at T0,heart rate(HR)and blood oxygen saturation at T0-T4 showed no significant difference between groups(P>0.05).Ramsay sedation scores and Steward recovery scores of the observation group were higher than those of the control group(P<0.05).The classification of emergence agitation in the two groups was similar(P<0.05).There were statistically significant differences in Visual Analogue Scale(VAS)scores of both groups in resting state and motion state in terms of time effect,inter-group effect and interaction effect(P<0.05).The VAS scores of the observation group in resting state and motion state at 12h and 24h after operation were lower than those of the control group(P<0.05).There was no statistically significant difference in VAS score between the two groups at 6h and 48h after operation(P>0.05).The postoperative adverse

关 键 词：胸椎旁神经阻滞 镇痛 腹腔镜肾切除术 血流动力学 苏醒质量 

分 类 号：R614.4[医药卫生—麻醉学] R699.2[医药卫生—外科学]