本文關(guān)鍵詞：超聲引導(dǎo)下胸椎椎旁神經(jīng)阻滯復(fù)合全身麻醉在肝部分切除術(shù)中的應(yīng)用　出處：《新鄉(xiāng)醫(yī)學(xué)院學(xué)報(bào)》2016年04期 　論文類型：期刊論文

  更多相關(guān)文章： 胸椎 椎旁神經(jīng)阻滯 肝部分切除術(shù) 超聲引導(dǎo) 全身麻醉 肝細(xì)胞癌

【摘要】：目的探討超聲引導(dǎo)下胸椎椎旁神經(jīng)阻滯(TPVB)復(fù)合全身麻醉在肝部分切除術(shù)中的應(yīng)用效果。方法80例擇期行肝右葉部分切除術(shù)的肝細(xì)胞癌患者分為觀察組和對照組,每組40例。對照組患者給予喉罩吸入全身麻醉,觀察組患者給予超聲引導(dǎo)下TPVB復(fù)合喉罩吸入全身麻醉;觀察2組患者麻醉后加強(qiáng)監(jiān)護(hù)病房(PACU)停留時間、術(shù)中及PACU觀察期間舒芬太尼使用量、術(shù)后48 h疼痛視覺模擬評分(VAS)4的病例數(shù)、術(shù)后48 h內(nèi)患者單次使用自控靜脈鎮(zhèn)痛(PCIA)次數(shù)及術(shù)后并發(fā)癥發(fā)生情況。結(jié)果 2組患者手術(shù)時間、術(shù)中出血量、補(bǔ)液量及尿量比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前、切皮時、術(shù)中30 min時2組患者平均動脈壓(MAP)、心率(HR)、血氧飽和度(Sp O2)及體溫比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);手術(shù)結(jié)束拔除喉罩后患者Aldrete評分達(dá)到出蘇醒室標(biāo)準(zhǔn)時觀察組患者M(jìn)AP、HR低于對照組(P0.05),但2組患者Sp O2及體溫比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組患者PACU停留時間顯著短于對照組(P0.01),觀察組患者術(shù)中及在PACU停留期間舒芬太尼使用量均顯著少于對照組(P0.01)。術(shù)后1、6、12 h,觀察組疼痛VAS評分4的患者例數(shù)顯著少于對照組(P0.05)。在術(shù)后0~1、1~6、6~12、12~24及0~48 h,觀察組患者單次使用PCIA的次數(shù)顯著少于對照組(P0.05,P0.01)。觀察組患者術(shù)后惡心嘔吐及呼吸抑制發(fā)生率顯著低于對照組(P0.05)。結(jié)論超聲引導(dǎo)下TPVB復(fù)合喉罩吸入全身麻醉可以減少術(shù)中和術(shù)后阿片類藥物使用量,縮短PACU停留時間,減輕患者術(shù)后疼痛,減少術(shù)后并發(fā)癥。
[Abstract]:Objective to investigate the thoracic paravertebral nerve block (TPVB) guided by ultrasound. Methods 80 patients with hepatocellular carcinoma undergoing partial hepatectomy were divided into observation group and control group. 40 cases in each group. The patients in the control group were given laryngeal mask inhalation general anesthesia, while the patients in the observation group were given TPVB combined laryngeal mask inhalation general anesthesia under the guidance of ultrasound. The duration of stay in intensive care unit after anesthesia, the amount of sufentanil used during operation and PACU observation, and the number of patients with visual analogue score of pain and visual analogue score of VAS4 at 48 hours after operation were observed in both groups. Results the time of operation and the amount of blood loss during operation were observed in two groups. There was no significant difference in fluid resuscitation and urine volume between the two groups (P 0.05). The mean arterial pressure (MAPP) and heart rate (HR) were observed in the two groups at 30 min before operation and 30 min after skin incision. There was no significant difference in blood oxygen saturation (Sp O 2) and body temperature (P 0.05). At the end of operation, the Aldrete score of patients with laryngeal mask was lower than that of the control group (P 0.05). However, there was no significant difference in SPO _ 2 and body temperature between the two groups. The PACU residence time in the observation group was significantly shorter than that in the control group (P 0.01). The dosage of sufentanil during operation and stay in PACU in the observation group was significantly lower than that in the control group (P 0.01). The number of patients with pain VAS score 4 in the observation group was significantly lower than that in the control group (P 0.05). The frequency of single use of PCIA in the observation group was significantly lower than that in the control group (P0.05). The incidence of nausea and vomiting and respiratory depression in the observation group was significantly lower than that in the control group (P 0.05). Conclusion Ultrasound-guided TPVB combined with laryngeal mask inhalation general anesthesia can reduce the use of opioid drugs during and after operation. The duration of PACU stay was shortened, the postoperative pain was alleviated, and postoperative complications were reduced.
【作者單位】： 佛山市順德區(qū)均安醫(yī)院麻醉科;
【分類號】：R614;R735.7
【正文快照】： 肝細(xì)胞癌(hepatocellular carcinoma,HCC)是常見的惡性腫瘤,肝部分切除術(shù)(partial hepatectomy,PH)是肝細(xì)胞癌有效的治療方法[1]。由于該手術(shù)創(chuàng)傷大,牽拉反應(yīng)明顯,肌肉松弛要求高等,PH常在氣管插管全身麻醉或喉罩(laryngeal mask airway,LMA)通氣全身麻醉下進(jìn)行,但全身麻醉后

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