本文關鍵詞：Narcotrend監(jiān)測下全身麻醉復合椎旁神經阻滯用于胸腹腔鏡聯(lián)合食管癌根治術效果觀察　出處：《山東醫(yī)藥》2016年40期 　論文類型：期刊論文

  更多相關文章： 食管癌 胸腹腔鏡聯(lián)合食管癌根治術 椎旁神經阻滯 麻醉深度監(jiān)測

【摘要】：目的觀察Narcot_rend監(jiān)測下全身麻醉復合椎旁神經阻滯(PVB)在胸腹腔鏡聯(lián)合食管癌根治術(TLE)中的應用效果及安全性。方法選擇擇期行TLE的食管癌患者50例,隨機分為全身麻醉組(G組)、PVB復合全身麻醉組(P+G組),每組25例。G組直接予以全身麻醉,P+G組在超聲引導下行PVB,右T5椎旁間隙、雙側T8椎旁間隙分別予以0.5%羅哌卡因10 m L,記錄起效時間、阻滯平面后,予以全身麻醉;術中監(jiān)測平均動脈壓(MAP)、心率(HR)、Narcot_rend指數(shù)(NTI)[分別記錄基礎時(t_0)、神經阻滯后全麻誘導前(t_1)、全麻誘導后(t_2)、胸腔鏡手術切皮時(t_3)、胸腔鏡手術1 h時(t_4)、腹腔鏡手術切皮時(t_5)、腹腔鏡手術1 h時(t_6)、手術結束時(t_7)、氣管拔管時(t_8)、出麻醉恢復室(PACU)時(t_9)];術畢兩組均予舒芬太尼靜脈鎮(zhèn)痛,記錄術中丙泊酚、瑞芬太尼用量;記錄拔管時間、PACU停留時間;記錄患者術后安靜和咳嗽時視覺模擬評分(VAS)、舒芬太尼用量、并發(fā)癥發(fā)生情況等。結果P+G組感覺阻滯平面右側為T3~11,左側為T6~11。與G組比較,P+G組術中丙泊酚、瑞芬太尼用量減少(P均0.05),清醒至拔管時間、PACU停留時間縮短(P0.05或0.01);兩組t_8和t_9時點MAP均升高,但P+G組升高幅度均小于G組(P均0.05);P+G組t_3、t_4、t_6時點NTI均高于G組同時點(P均0.05);P+G組術后8 h內安靜和咳嗽時VAS、舒芬太尼用量均低于G組(P均0.05)。兩組均未發(fā)生術中知曉。結論 Narcot_rend監(jiān)測下PVB復合全身麻醉用于TLE的麻醉深度適宜,鎮(zhèn)痛效果較好,術中血流動力學穩(wěn)定。
[Abstract]:Objective to observe the application of general anesthesia combined with paravertebral nerve block under Narcot_rend monitoring in thoracic laparoscopy combined with radical resection of esophageal carcinoma. Methods 50 patients with TLE were selected. The patients were randomly divided into general anesthesia group (group G) and general anesthesia group (group P G). 25 patients in each group were given PVB under ultrasound guidance. Right T5 paravertebral space and bilateral T8 paraspinal space were treated with 0.5% ropivacaine 10 mL, respectively. The onset time was recorded. After block plane, general anesthesia was given. Intraoperative monitoring of mean arterial pressure MAPV, heart rate (HRT) and Narcottirend index (NTI). [The number of cases were recorded respectively, after general anesthesia induction, before general anesthesia induction, after general anesthesia induction, after general anesthesia induction, after general anesthesia induction, at the time of skin incision by thoracoscopic surgery, at T _ 3s, and at 1 hour after thoracoscopic surgery, by T _ 4). At the end of the operation, there were 5 cases of skin incision, 1 hour of laparoscopic surgery, 1 hour of operation, 1 hour after operation, and 1 hour after operation. At the end of the operation, there was no significant difference between the two groups, and at the end of the operation, there was no significant difference between them. When the anaesthesia recovery room (PACUU) is out of the anaesthesia recovery room, there is no t _ (9)]; Both groups were given sufentanil intravenous analgesia at the end of operation. The dosage of propofol and remifentanil were recorded. The time of extubation and the residence time of PACU were recorded. Visual analogue score (VASA), sufentanil dosage and complications were recorded during postoperative quiet and cough. Results the right side of sensory block level in group P G was T 3n 11. Compared with group G, the dosage of propofol and remifentanil were decreased by 0.05, and the time from waking to extubation. The residence time of PACU was shortened (P0.05 or 0.01). At the time points of t8 and t9, MAP increased in both groups, but the amplitude of increase in group P G was lower than that in group G (P 0.05). The NTI at the time point of T _ 3 / T _ 4 / T _ 6 in group P _ G was higher than that in group G (P < 0.05). In P G group, VAS occurred at rest and cough within 8 hours after operation. The dosage of sufentanil was lower than that of group G (P < 0.05). There was no intraoperative knowledge in both groups. Conclusion PVB combined with general anesthesia under Narcot_rend monitoring is suitable for TLE anesthesia. The analgesic effect was better and hemodynamics was stable during operation.
【作者單位】： 安徽醫(yī)科大學附屬省立醫(yī)院;
【分類號】：R614
【正文快照】： 硬膜外鎮(zhèn)痛是胸腹腔鏡聯(lián)合食管癌根治術(TLE)傳統(tǒng)的鎮(zhèn)痛方法。但隨著抗凝藥物的廣泛使用,極易誘發(fā)硬膜外血腫;而且靜脈麻醉隨著麻醉藥用量的增加,會導致患者嗜睡,影響術后咳嗽、咳痰及下床活動。椎旁神經阻滯(PVB)推薦用于胸科手術鎮(zhèn)痛,其用于TLE術后鎮(zhèn)痛鮮有報道[1]。在全身

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