食管癌根治术超声引导下椎旁神经阻滞联合全身麻醉应用效果

Effect of ultrasound-guided paravertebral nerve block combined with general anesthesia in radical esophagectomy

目的探讨超声引导下椎旁神经阻滞(USG-PVB)联合全身麻醉在食管癌根治术中的应用价值。方法选取阳谷县人民医院2017-05-01-2020-02-28拟接受全麻下胸腔镜食管癌根治术的100例患者为研究对象,采用组间匹配的方法分为观察组与对照组,各50例。2组均实施全麻下胸腔镜食管癌根治术,观察组同时采用USG-PVB实施麻醉。术后2组患者均采用静脉自控镇痛(PICA)。对比2组血流动力学参数、血浆血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、术中麻醉药物用量及麻醉相关不良反应。结果T0~T3时刻,2组患者的心排量(CO)和每搏输出量(SV)测定值差异无统计学意义,均P>0.05。T1时刻,观察组患者的心脏指数(CI)值为(2.49±0.31)L/(min·m2),高于对照组的(2.33±0.27)L/(min·m2),t=2.752,P=0.007;T2时刻,CI值为(2.57±0.25)L/(min·m2),高于对照组的(2.44±0.28)L/(min·m2),t=2.449,P=0.016。T1时刻,观察组患者的平均动脉压(MAP)值为(88.40±3.95)mm Hg,高于对照组的(86.24±4.20)mm Hg,t=2.649,P=0.009;T2时刻为(98.74±4.00)mm Hg,低于对照组的(103.14±4.12)mm Hg,t=-5.418,P<0.001。在术前,2组患者的AngⅡ、Cor、TNF-α及IL-6测定值差异无统计学意义,均P>0.05;术后24h,观察组患者Cor、TNF-α及IL-6测定值分别为(286.2±32.0)ng/mL、(46.20±12.57)pg/mL和(96.20±15.42)pg/mL,均低于对照组的(303.8±34.7)ng/mL、(56.63±14.24)pg/mL和(108.74±16.58)pg/mL,差异有统计学意义,均P<0.05。2组患者的手术时间差异无统计学意义,P>0.05;观察组患者拔管时间、丙泊酚用量、瑞芬太尼用量和舒芬太尼用量分别为(28.5±4.2)min、(1233.0±126.8)mg、(3369.4±220.1)μg和(56.7±8.2)μg,均低于对照组的(34.0±5.8)min、(1328.1±130.6)mg、(3636.7±241.4)μg和(63.8±8.7)μg,差异有统计学意义,均P<0.05。观察组的麻醉相关性不良反应发生率为12.00%,低于对照组的28.00%,差异有统计学意义,χ2=4.000,P=0.046。结论食管癌根治术中,USG-PVB联合全麻能减少术中麻醉药物的用量、维持术中血流动学分稳定、降低手术引起的应激及炎症反应程度。

Objective To explore the value of ultrasound-guided paravertebral nerve block(USG-PVB)combined with general anesthesia in radical resection of esophageal cancer.Methods A total of 100 patients with esophageal cancer undergoing thoracoscopic radical resection under general anesthesia in Yanggu County People’s Hospital from May 1,2017 to February 28,2020 were selected as the research objects,and use a random number table to divide them into a combined group and a general anesthesia group with 50 cases each.Both groups will undergo thoracoscopic radical esophageal cancer surgery under general anesthesia.The group was anesthetized with USG-PVB at the same time,both groups of patients received intravenous controlled analgesia(PICA).The hemodynamic parameters,plasma angiotensinⅡ(AngⅡ),cortisol(Cor),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),intraoperative anesthetic drug consumption,anesthesia-related adverse reactions.Results At T0-T3,there was no significant difference in cardiac output(CO)and stroke volume(SV)between the combined group and the general anesthesia group(P>0.05).At T1,T2,the cardiac index(CI)value of the combined group(2.49±0.31,2.57±0.25)was higher than that of the general anesthesia group(2.33±0.27,2.44±0.28),t=2.752,2.449,P=0.007,0.016.The mean arterial pressure(MAP)value of patients in the combined group(88.40±3.95)was higher than that of the general anesthesia group(86.24±4.20)at T1(t=2.649,P=0.009),and lower than that of the general anesthesia group(98.74±4.00 vs 103.14±4.12)at T2(t=-5.418,P<0.001).Before the operation,the AngⅡof the combined group and the general anesthesia group There was no significant difference in the measured values of Cor,TNF-αand IL-6(P>0.05).24 hours after the operation,the measured values of Cor,TNF-α,and IL-6 in the combined group(286.2±32.0,46.20±12.57,96.20±15.42)were lower than those in the general anesthesia group(303.8±34.7,56.63±14.24,108.74±16.58).The difference was Statistically significant(P<0.05).There was no statistically significant difference in operation time between the combined group and the general anesthesia group(P>0.05).The combined group patients’extubation time,propofol dosage,remifentanil dosage,and comfort the dosage of fentanyl(28.5±4.2,1233.0±126.8,3369.4±220.1,56.7±8.2)was lower than that of the general anesthesia group(34.0±5.8,1328.1±130.6,3636.7±241.4,63.8±8.7),and the difference was statistically significant(P<0.05).The incidence of anesthesia-related adverse reactions in the combined group was 12.00%lower than that of the general anesthesia group,and the difference was statistically significant(χ2=4.000,P=0.046).Conclusion The application of USG-PVB combined with general anesthesia in radical resection of esophageal cancer can reduce the amount of intraoperative anesthetics,maintain the stability of intraoperative blood flow,and reduce the degree of stress and inflammation caused by surgery.