本文選題：胸椎旁神經(jīng)阻滯 + 超聲引導��； 參考：《臨床麻醉學雜志》2015年01期

【摘要】：目的觀察超聲引導胸椎旁神經(jīng)阻滯對食管癌手術(shù)患者循環(huán)及應激反應的影響。方法擇期食管癌開胸手術(shù)患者40例,隨機均分為胸椎旁神經(jīng)阻滯復合全麻組(A組)和單純?nèi)榻M(B組)。兩組全麻方法相同,A組于全麻誘導前行超聲引導下胸椎旁神經(jīng)阻滯,術(shù)后兩組均采用患者靜脈自控鎮(zhèn)痛(PCIA)。記錄患者全麻藥物用量及麻醉前(T1)、誘導前(T2)、氣管插管即刻(T3)、手術(shù)2h(T4)、術(shù)畢(T5)、術(shù)后1h(T6)、4h(T7)、8h(T8)、24h(T9)、48h(T10)的SBP、DBP、HR、SpO2,記錄T6~T10時疼痛VAS評分、Ramsay鎮(zhèn)靜評分,并于T1、T4、T5、T9時抽血檢測血糖、腎上腺素(E)、去甲腎上腺素(NE)、多巴胺(DA)濃度。結(jié)果 A組患者術(shù)中丙泊酚用量、瑞芬太尼用量明顯少于B組(P0.05)。兩組患者術(shù)中血流動力學平穩(wěn),術(shù)后A組T6~T9安靜時和活動時的疼痛VAS評分均明顯低于B組(P0.05),Ramsay鎮(zhèn)靜評分差異無統(tǒng)計學意義。兩組T9時血糖、NE均明顯高于T1、T4、T5時,T4、T5時E均明顯低于T1、T9時,B組T9時DA明顯高于T1、T4、T5時(P0.05),B組T9時血糖、NE、E、DA均明顯高于A組(P0.05)。結(jié)論超聲引導胸椎旁神經(jīng)阻滯復合全麻用于食管癌手術(shù)安全有效,較單純?nèi)槟芨玫匾种茟し磻?減少全麻藥物的使用。
[Abstract]:Objective to observe the effect of thoracic paravertebral nerve block guided by ultrasound on circulation and stress response in patients with esophageal carcinoma. Methods 40 patients with esophageal carcinoma undergoing thoracotomy were randomly divided into two groups: group A (group A) with paraspinal nerve block combined with general anesthesia (group A) and group B (group B) with simple general anesthesia. The two groups had the same general anesthesia method: group A was guided by ultrasound to block the paravertebral nerve before induction of general anesthesia, and both groups were treated with PCIA after operation. The dosage of general anesthetic and the time before anesthesia were recorded. Before induction, T2 was induced, T3 was immediately inserted in tracheal intubation, 2 h after operation, T5 was completed, and 1 h after operation, T6, T6, T7, T7, T7, T8, T9, T10) were recorded. The VAS score of pain during T6~T10 was measured by Ramsay sedative score and blood glucose was measured at T1 T4T5 / T9. The concentration of epinephrine, norepinephrine (NE), dopamine (DA). Results the dosage of propofol and remifentanil in group A was significantly lower than that in group B (P 0.05). The hemodynamics of the two groups was stable during operation, and the VAS score of T6~T9 in group A was significantly lower than that in group B during rest and movement, and there was no significant difference in sedative score between group A and group B. In both groups, blood glucose NE at T9 was significantly higher than that in T1T4, T5, T4 and T5 were significantly lower than that in T9 and DA in T9 was significantly higher than that in T9 in T1, T0. 05 and T5 in T9, and higher in Group A than that in Group A at T9, and in Group B, it was significantly higher than that in Group A at T9, and that in Group B was significantly higher than that in Group A. Conclusion Ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia is safe and effective in the operation of esophageal carcinoma. It is more effective than general anesthesia alone in inhibiting stress response and reducing the use of general anesthesia drugs.
【作者單位】： 江蘇省腫瘤醫(yī)院麻醉科;
【基金】：江蘇省腫瘤醫(yī)院青年基金(ZQ201204)
【分類號】：R614;R735.1

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