全凭静脉麻醉复合椎旁神经阻滞对胸腔镜下肺病损切除术患者应激反应、血流动力学及术后镇痛的影响

目的:研究全凭静脉麻醉复合胸椎旁神经阻滞(TPVB)对胸腔镜下肺病损切除术患者应激反应、血流动力学及术后镇痛的影响。方法:选择2016年6月至2017年12月在我院行胸腔镜下肺病损切除术的80例患者为研究对象。采用简单随机抽样方法,分为对照组(n=40)和观察组(n=40)。对照组行单纯全身麻醉,观察组在超声引导下行TPVB复合全身麻醉。比较两组麻醉前、术毕、术后24 h的血糖、肾上腺素(E)、去甲肾上腺素(NE)及多巴胺(DA)的浓度,以及两组在麻醉时、手术开始时、手术开始后0.5 h、手术开始后1 h、术毕时的平均动脉压(MAP)和心率(HR),同时比较两组术后2 h、6 h、12 h、24 h静息及活动时的视觉模拟评分(VAS)及相关并发症的发生率。结果:两组患者在麻醉前及术毕的各应激反应指标比较无差异(P0.05),而术后24 h比较,观察组低于对照组(P0.05);两组患者麻醉时的MAP、HR比较无差异(P0.05),除手术开始后1 h和术毕的HR外,观察组各时间的MAP、HR均显著低于对照组(P0.05);除静息时24 h外,观察组各时间静息时和活动时的VAS评分均低于对照组(P0.05);两组患者术后各并发症的发生率比较无统计学差异(P0.05)。结论:全凭静脉麻醉复合TPVB在胸腔镜下肺病损切除术中应激反应小,对血流动力学的波动影响小,术后镇痛效果良好,且安全有效。

Effect of Total Intravenous Anesthesia Combine with Thoracic Paravertebral Nerve Block on Stress Response, Hemodynamics and Postoperative Analgesia in Patients Undergoing Thoracoscopic Lung Lesion Resection

ABSTRACT Objective: To investigate the effects of total intravenous anesthesia combine with thoracic paravertebral nerve block (TPVB) on stress response, hemodynamics and postoperative analgesia in patients undergoing thoracoscopic lung lesion resection. Methods: 80 patients who underwent thoracoscopic lung lesion resection in our hospital were selected as the research objects from June 2016 to December 2017. Using simple random sampling method, the subjects were divided into observation group(n=40) and control group(n=40). The control group received simple general anesthesia, and the observation group received general anesthesia combined TPVB under the guidance of ultrasound. The concentration of blood glucose, adrenaline (E), norepinephrine (NE) and dopamine (DA) in the two groups were compared before anesthesia, after surgery and postoperative 24 h. The average arterial pressure (MAP), heart rate (HR) of the two groups at the time of anaesthesia, beginning of the operation, 0.5 h after the operation, 1 h after the operation, postopera- tive. And the visual analogue (VAS) and the incidence of related complications were compared between the two groups of 2 h, 6 h, 12 h, 24 h after the operation. Results: There were no differences in the indexes of stress response between the two groups before and after the anesthesia(P>0.05), the observation group 24 h after the operation was lower than the control group (P<0.05). There were no differences in MAP and HR between the two groups(P>0.05). HR except for 1h after operation and postoperative, the MAP and HR of the observa- tion group were significantly lower than those of the control group(P<0.05). Except for resting 24 h, the VAS scores at rest time and ac- tivity time in observation group were lower than those in control group(P<0.05). There was no significant difference in incidence of com- plications between two groups(P>0.05). Conclusion: Total intravenous anesthesia combine with TPVB are applied in thoracoscopic lung lesion resection, stress response is small, hemodynamic fluctuations are stable, postoperative analgesia effect was good, safe and effective.