全身麻醉联合连续椎旁神经阻滞在胸腹腔镜联合食管癌根治术中的应用
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摘要
目的研究全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术效果。方法选择广东省梅州市人民医院胸外科2016年5月-2017年12月收治食管癌根治术患者90例为研究对象,随机分为3组, A组(n=30)采取气管内插管全身麻醉下完成食管癌根治术,B组(n=30)采取全身麻醉联合硬膜外阻滞下完成手术治疗;C组(n=30)采取全身麻醉联合连续椎旁神经阻滞。比较3组患者不同时间点心率(HR)、平均动脉压(MAP)、术中七氟烷、舒芬太尼用量,苏醒相关指标和不良反应发生率。结果与A组比较,B组患者T_1、T_2、T_3、T_4时刻MAP降低,T_1、T_2、T_3时刻HR降低,差异均有统计学意义(P<0.05);C组患者T_2、T_3时刻MAP降低,T_2时刻HR降低,差异均有统计学意义(P<0.05); B、C组患者七氟烷、舒芬太尼用量、拔管后5 min视觉模拟评分法(VAS)评分均降低,睁眼时间、定向力恢复时间、拔管时间、呼吸恢复时间均缩短,差异均有统计学意义(P<0.05)。3组患者不良反应比较,差异无统计学意义(P>0.05)。结论全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术血流动力学平稳,且可减少麻醉药物用量,应用安全。
Objective To study the effect of general anesthesia combined with continuous paravertebral nerve block in radical esophagectomy. Methods 90 patients who admitted to department of thoracic surgery of Meizhou people′s hospital from May 2016 to December 2017 and underwent radical surgery for esophageal carcinoma were enrolled, and they were randomly divided into 3 groups. Endotracheal intubation under general anesthesia to complete the radical resection of esophageal cancer was conducted in Group A(n=30). General anesthesia combined with epidural block to complete the surgical treatment was conducted in Group B(n=30). General anesthesia combined with continuous paravertebral nerve block was conducted in Group C(n=30). Heart rate(HR), mean arterial pressure(MAP), intraoperative sevoflurane and sufentanil dosages, indexes related to recovery and incidence of adverse reactions were compared among the 3 groups at different time points. Results MAP of the group C were lower than that of the group A at T2, T3 moments. HR was lower than that of group A T2 time(P<0.05). MAP and HR of the Group B at T1, T2 and T3 moment were lower than group A(P<0.05). The dosage of Sevoflurane and sufentanil of the Group B and group C were lower. VAS scores of the Group B and group C were lower in 5 min after extubation. Awake time, directional force recovery time and extubation time and breathing recovery time of the Group B and group C were shorter(P<0.05). Adverse reactions of three groups were no statistically significant difference(P>0.05). Conclusion General anesthesia combined by the continuous hemodynamic stable nerve block used in esophageal cancer radical, and could reduce the dosage of anesthetic drugs, application security.
Objective To study the effect of general anesthesia combined with continuous paravertebral nerve block in radical esophagectomy. Methods 90 patients who admitted to department of thoracic surgery of Meizhou people′s hospital from May 2016 to December 2017 and underwent radical surgery for esophageal carcinoma were enrolled, and they were randomly divided into 3 groups. Endotracheal intubation under general anesthesia to complete the radical resection of esophageal cancer was conducted in Group A(n=30). General anesthesia combined with epidural block to complete the surgical treatment was conducted in Group B(n=30). General anesthesia combined with continuous paravertebral nerve block was conducted in Group C(n=30). Heart rate(HR), mean arterial pressure(MAP), intraoperative sevoflurane and sufentanil dosages, indexes related to recovery and incidence of adverse reactions were compared among the 3 groups at different time points. Results MAP of the group C were lower than that of the group A at T2, T3 moments. HR was lower than that of group A T2 time(P<0.05). MAP and HR of the Group B at T1, T2 and T3 moment were lower than group A(P<0.05). The dosage of Sevoflurane and sufentanil of the Group B and group C were lower. VAS scores of the Group B and group C were lower in 5 min after extubation. Awake time, directional force recovery time and extubation time and breathing recovery time of the Group B and group C were shorter(P<0.05). Adverse reactions of three groups were no statistically significant difference(P>0.05). Conclusion General anesthesia combined by the continuous hemodynamic stable nerve block used in esophageal cancer radical, and could reduce the dosage of anesthetic drugs, application security.
引文
[1] 崔文峰,曹纪伟,巴玉峰. 胸腹腔镜食管癌根治术对老年食管癌患者肺功能及炎症因子的影响[J].肿瘤学杂志,2017,23(9):823-826.
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[6] BOVA J F, CUNHA F D,STOUT R W, et al. Bupivacaine mandibular nerve block affects intraoperative blood pressure and heart rate in a yucatan miniature swine mandibular condylectomy model:a pilot study[J]. J Invest Surg,2015,28(1):32-39.
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[10] WARDHAN R,AOUROUX A S, BEN-DAVID B, et al. Is L2 paravertebral block comparable to lumbar plexus block for postoperative qnalgesia qfter total hip arthroplasty[J].Clin Orthop Relat Res,2014,472(5):1475-1481.
[11] 李兰兰,孙振涛,韩雪萍,等.椎旁神经阻滞复合全麻对肝移植手术炎性反应及血流动力学的影响[J].医学与哲学,2015,36(14):38-39,70.
[12] SYAL K,CHAMDEL A.Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy:A randomised double-blind trial[J].Indian J Anaesth,2017,61(8):643-648.
[13] TULAY I C,SURHAN O C,SIBEL O,et al.Comparison of spinal anaesthesia and paravertebral block in unilateral inguinal hernia repair[J].Turk J Anaesthesiol Reaniation,2014,42(5):257-263.
[14] 刘伟,孙前闯,宋智敏,等.超声引导下椎旁神经阻滞在老年人开胸手术术后镇痛中的疗效[J].中国老年学杂志,2015,11(7):1854-1855.
[15] 王瑞枝,杜雪江.椎旁神经阻滞对开胸术患者超前镇痛的作用分析[J].局解手术学杂志,2017,26(4):271-273.
[16] 王莉娟,马民玉,孙振涛,等.帕瑞昔布钠联合超声引导椎旁神经阻滞用于胸科手术多模式镇痛的临床研究[J].中华实验外科杂志,2016,33(9):2223-2226.
[2] 章蔚,李娟,耿擎天,等.单点或多点胸椎旁神经阻滞在胸腔镜肺叶切除患者术后镇痛的临床研究[J].临床麻醉学杂志,2014,30(2):109-113.
[3] BRIAN M, ILFELD M D, SARAH J,et al.Treatment of post-mastectomy pain with ambulatory continuous paravertebral nerve blocks:a randomized, triple-masked, placebo-controlled study[J].Reg Anesth Pain Med,2014,39(2):89-96.
[4] MESSEHA M M. Real-time ultrasound-guided comparison of adductor canal block and psoas compartment block combined with sciatic nerve block in laparoscopic knee surgeries[J].Anesth Essays Res,2016,10(2):305-311.
[5] 张勇,陈肖,曹苏,等.超声引导下连续椎旁神经阻滞对开胸手术炎性反应的影响[J].中华临床医师杂志,2014,12(24):4405-4409.
[6] BOVA J F, CUNHA F D,STOUT R W, et al. Bupivacaine mandibular nerve block affects intraoperative blood pressure and heart rate in a yucatan miniature swine mandibular condylectomy model:a pilot study[J]. J Invest Surg,2015,28(1):32-39.
[7] KANQ C M,KIM W J,YOON S H,et al.Postoperative pain control by intercostal nerve block after augmentation mammoplasty[J].Aesthetic Plast Surg, 2017,41(5):1031-1036.
[8] 章蔚,柴小青,魏昕,等.Narcotrend 监测下全身麻醉复合椎旁神经阻滞用于胸腹腔镜联合食管癌根治术效果观察[J].山东医药,2016,56(40):72-74.
[9] AQARWAL R R, WALLACE A M,MADISON S J,et al. Single-Injection thoracic paravertebral block and postoperative analgesia following mastectomy:a retrospective cohort study[J]. J Clin Anesth,2015,27(5):371-374.
[10] WARDHAN R,AOUROUX A S, BEN-DAVID B, et al. Is L2 paravertebral block comparable to lumbar plexus block for postoperative qnalgesia qfter total hip arthroplasty[J].Clin Orthop Relat Res,2014,472(5):1475-1481.
[11] 李兰兰,孙振涛,韩雪萍,等.椎旁神经阻滞复合全麻对肝移植手术炎性反应及血流动力学的影响[J].医学与哲学,2015,36(14):38-39,70.
[12] SYAL K,CHAMDEL A.Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy:A randomised double-blind trial[J].Indian J Anaesth,2017,61(8):643-648.
[13] TULAY I C,SURHAN O C,SIBEL O,et al.Comparison of spinal anaesthesia and paravertebral block in unilateral inguinal hernia repair[J].Turk J Anaesthesiol Reaniation,2014,42(5):257-263.
[14] 刘伟,孙前闯,宋智敏,等.超声引导下椎旁神经阻滞在老年人开胸手术术后镇痛中的疗效[J].中国老年学杂志,2015,11(7):1854-1855.
[15] 王瑞枝,杜雪江.椎旁神经阻滞对开胸术患者超前镇痛的作用分析[J].局解手术学杂志,2017,26(4):271-273.
[16] 王莉娟,马民玉,孙振涛,等.帕瑞昔布钠联合超声引导椎旁神经阻滞用于胸科手术多模式镇痛的临床研究[J].中华实验外科杂志,2016,33(9):2223-2226.