發(fā)布時間：2018-02-28 23:33

  本文關(guān)鍵詞： 胸椎旁神經(jīng)阻滯(TPVB) 早期恢復(fù)質(zhì)量 炎癥反應(yīng) 右美托嘧啶 超聲多普勒　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討超聲引導(dǎo)下右美托嘧啶聯(lián)合羅哌卡因胸椎旁神經(jīng)阻滯(TPVB)對胸腹腔鏡聯(lián)合食道癌切除術(shù)患者術(shù)后鎮(zhèn)痛、炎癥、早期恢復(fù)質(zhì)量的影響。方法:選擇行胸腹腔鏡聯(lián)合食道癌切除術(shù)患者90例,采用隨機數(shù)字表法分成三組(每組30人):羅哌卡因TPVB組(TS組)、右美托嘧啶聯(lián)合羅哌卡因TPVB組(TD組)和對照組(C組)。全身麻醉前15min,TS組、TD組分別在超聲引導(dǎo)下行右側(cè)胸6水平椎旁神經(jīng)阻滯,分別注入0.375%羅哌卡因20ml、lug/kg右美托嘧啶和0.375%羅哌卡因混合液20ml。三組全麻誘導(dǎo)和維持方法一致。三組術(shù)畢均采用電子泵靜脈自控鎮(zhèn)痛。記錄術(shù)后1h、2h、4h、8h、12h、24h的靜息、運動時(咳嗽和深壓腹部)疼痛視覺模擬評分(VAS評分);選擇術(shù)前(T1)、術(shù)中胸腔鏡進(jìn)胸時(T2)和術(shù)后24h(T3)抽靜脈血2ml,檢測血漿IL-6、IL-8濃度;記錄患者術(shù)中丙泊酚、瑞芬太尼用量以及術(shù)后一個月內(nèi)相關(guān)并發(fā)癥的發(fā)生率(如肺部感染,肺不張,呼吸衰竭,心律失常等)。采用QoR-40量表評價患者術(shù)前、術(shù)后3天和術(shù)后1個月的早期恢復(fù)質(zhì)量。結(jié)果:最終各組分別入選27人。1.與C組相比,TS組,TD組在術(shù)后3天,術(shù)后1個月時QOR-40總評分均顯著增高(p0.01),身體舒適度和情緒更好,自理能力及疼痛管理方面更強(p0.05),而與TS組相比,TD組在上述時間點時身體舒適度更佳(p0.05),同時情緒更樂觀,有更好的自理能力與疼痛控制(p0.05),QOR-40總評分更高(p0.05)。2.與C組相比,TD組與TS組靜息和運動狀態(tài)下在術(shù)后1h、2h、4h、8h、12h、24h各時刻VAS評分均顯著降低(p0.05),而與TS組相比,靜息和運動狀態(tài)下以上各時間點時TD組VAS評分也顯著降低(p0.05)。3.與C組相比,TD組與TS組在T2,T3時點血漿IL-6、IL-8水平均顯著降低(p0.01),與TS組相比,在T2,T3時點TD組IL-6、IL-8水平顯著降低(p0.05)。4.三組患者術(shù)后1個月內(nèi)均無肺部感染、肺不張、呼吸衰竭、心律失常相關(guān)并發(fā)癥。與C組相比,TS、TD組瑞芬太尼用量均明顯減少(p0.01),但TS組和TD組相比無差異(p0.05),術(shù)中三組患者丙泊酚用量無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:與單純?nèi)橄啾?胸椎旁阻滯復(fù)合全麻對胸腹腔鏡食道癌根治術(shù)患者而言可以明顯減輕術(shù)后疼痛,減弱圍術(shù)期手術(shù)炎癥反應(yīng),減少術(shù)中鎮(zhèn)痛藥物用量,顯著提高患者早期術(shù)后恢復(fù)質(zhì)量;與單純羅哌卡因TPVB相比,右美托嘧啶聯(lián)合羅哌卡因胸椎旁神經(jīng)阻滯在以上各方面更優(yōu),但對于術(shù)中鎮(zhèn)痛藥物用量無影響。
[Abstract]:Objective: to investigate the analgesia and inflammation of patients with thoracic paravertebral nerve block (TPVB) guided by right metopyrimidine and ropivacaine combined with thoracic laparoscopy and esophagectomy. Methods: 90 patients with thoracic laparoscopy combined with esophagectomy were selected. Three groups were randomly divided into three groups: ropivacaine TPVB group (TS group), dexmetropyrimidine combined ropivacaine TPVB group (TD group) and control group (group C). Thoracic 6 level paravertebral nerve block, 0.375% ropivacaine 20ml / kg dexmetropyrimidine and 0.375% ropivacaine were injected into 20ml 20 ml, respectively. The induction and maintenance of general anesthesia in the three groups were the same. The visual analogue score of pain during exercise (cough and deep pressure abdomen) and VAS score were used to measure the plasma IL-6 IL-8 concentration, and to record the propofol during operation. The dosage of remifentanil and the incidence of postoperative complications (such as pulmonary infection, atelectasis, respiratory failure, arrhythmia, etc.) were evaluated by QoR-40 scale before operation. Results: 27 patients were enrolled in each group respectively. Compared with group C, the total QOR-40 score of TD group was significantly higher than that of group C at 3 days and 1 month after operation, and the body comfort and mood were better. Compared with TS group, TD group was more comfortable than TS group in terms of self-care ability and pain management. Compared with group C, the VAS scores of TD and TS groups decreased significantly at 1 h, 2 h, 4 h, 8 h and 12 h at 24 h after operation, and compared with those in TS group, the total score of P0.05 was significantly lower than that in group C, and compared with that in group C, the total score of QOR-40 was significantly lower than that in group C, compared with that in group C, which was significantly lower than that in group C at 1 h, 2 h, 4 h, 8 h, 8 h, 12 h and 24 h after operation, compared with that in group C. The VAS score of TD group was significantly lower than that of group C at rest and exercise. Compared with group C, the levels of IL-6 and IL-8 in TD group and TS group were significantly lower than those in group C at T2T 3, compared with those in TS group. The levels of IL-6 and IL-8 in TD group were significantly decreased at T _ 2 / T _ 3. There was no pulmonary infection, atelectasis, respiratory failure in all three groups within one month after operation. Compared with group C, the dosage of remifentanil decreased significantly in group C, but there was no difference in dosage of propofol between group TS and group TD (P 0.05). Conclusion: compared with general anesthesia alone, the dosage of propofol was not significantly different among the three groups. Thoracic paravertebral block combined with general anesthesia can significantly reduce postoperative pain, reduce perioperative inflammatory reaction, reduce the amount of intraoperative analgesic drugs, and significantly improve the quality of early postoperative recovery in patients with thoracic laparoscopic radical esophagectomy. Compared with ropivacaine TPVB alone, dexmetropyrimidine combined with ropivacaine was better in paravertebral thoracic nerve block than ropivacaine alone, but had no effect on intraoperative analgesic dosage.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614;R735.1

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