本文選題：高原低氧環(huán)境 + 胸椎旁神經(jīng)根阻滯��； 參考：《中國老年學雜志》2017年10期

【摘要】：目的探討胸椎旁神經(jīng)阻滯(TPVB)對高原低氧環(huán)境下老年開胸患者應激反應、循環(huán)功能及術(shù)后鎮(zhèn)痛效果的影響。方法選擇2013年4月至2015年4月擬行開胸手術(shù)的老年患者86例,采用隨機數(shù)字表法分為觀察組和對照組各43例,均給予全身麻醉,對照組術(shù)后采用靜脈自控鎮(zhèn)痛,觀察組采用超聲引導下胸椎旁神經(jīng)阻滯,比較兩組不同時點應激反應、循環(huán)功能、疼痛程度及不良反應。結(jié)果氣管插管即刻(T1)、氣管插管后30 min(T2)、手術(shù)結(jié)束時(T3)觀察組血清腎上腺素(E)、去腎上腺素(NE)、多巴胺(DA)含量均明顯低于對照組(P0.001);T1、T2、T3時點,觀察組心率(HR)明顯高于對照組,平均動脈血壓(MAP)明顯低于對照組(P0.05);術(shù)后1、6、24、48 h,觀察組靜止和咳嗽、活動狀態(tài)時疼痛評分均明顯低于對照組(P0.05或P0.001);術(shù)后惡心、嘔吐、呼吸抑制等不良反應明顯低于對照組(20.93%vs 73.71%,9.30%vs 25.58%,2.33%vs27.91%)(χ~2=3.957~10.965,P0.05,P0.001)。結(jié)論超聲引導下TPVB麻醉有助于減輕高原地區(qū)低氧環(huán)境下老年開胸手術(shù)患者應激反應,維持血流動力學相對穩(wěn)定,緩解術(shù)后疼痛程度,減少術(shù)后并發(fā)癥的發(fā)生。
[Abstract]:Objective to investigate the effects of thoracic paraspinal nerve block (TPVB) on stress response, circulatory function and postoperative analgesia in elderly patients with thoracotomy under high altitude hypoxia.Methods 86 elderly patients undergoing thoracotomy from April 2013 to April 2015 were randomly divided into observation group (n = 43) and control group (n = 43).The stress response, circulatory function, pain degree and adverse reaction were compared between the two groups under ultrasound guided paraspinal nerve block.Results the serum levels of epinephrine, noradrenaline and dopamine were significantly lower in the observation group than in the control group at 30 min after tracheal intubation and 30 min after tracheal intubation, and at the end of the operation. The heart rate of the observation group was significantly higher than that of the control group.Conclusion Ultrasound-guided TPVB anesthesia can reduce stress response, maintain hemodynamic stability, relieve postoperative pain and reduce postoperative complications in elderly patients undergoing thoracotomy under high altitude hypoxia.
【作者單位】： 西寧市第三醫(yī)院麻醉科;
【分類號】：R614

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