超声引导下胸椎椎旁神经阻滞复合全身麻醉在肝部分切除术中的应用

Application of thoracic paravertebral block by ultrasonic guidance combined with general anaesthesia in partial hepatectomy

目的探讨超声引导下胸椎椎旁神经阻滞（TPVB）复合全身麻醉在肝部分切除术中的应用效果。方法80例择期行肝右叶部分切除术的肝细胞癌患者分为观察组和对照组,每组40例。对照组患者给予喉罩吸入全身麻醉,观察组患者给予超声引导下TPVB复合喉罩吸入全身麻醉;观察2组患者麻醉后加强监护病房（PACU）停留时间、术中及PACU观察期间舒芬太尼使用量、术后48 h疼痛视觉模拟评分（VAS）〉4的病例数、术后48 h内患者单次使用自控静脉镇痛（PCIA）次数及术后并发症发生情况。结果 2组患者手术时间、术中出血量、补液量及尿量比较差异均无统计学意义（P〉0.05）。术前、切皮时、术中30 min时2组患者平均动脉压（MAP）、心率（HR）、血氧饱和度（Sp O2）及体温比较差异均无统计学意义（P〉0.05）;手术结束拔除喉罩后患者Aldrete评分达到出苏醒室标准时观察组患者MAP、HR低于对照组（P〈0.05）,但2组患者Sp O2及体温比较差异无统计学意义（P〉0.05）。观察组患者PACU停留时间显著短于对照组（P〈0.01）,观察组患者术中及在PACU停留期间舒芬太尼使用量均显著少于对照组（P〈0.01）。术后1、6、12 h,观察组疼痛VAS评分〉4的患者例数显著少于对照组（P〈0.05）。在术后0~1、〉1~6、〉6~12、〉12~24及0~48 h,观察组患者单次使用PCIA的次数显著少于对照组（P〈0.05,P〈0.01）。观察组患者术后恶心呕吐及呼吸抑制发生率显著低于对照组（P〈0.05）。结论超声引导下TPVB复合喉罩吸入全身麻醉可以减少术中和术后阿片类药物使用量,缩短PACU停留时间,减轻患者术后疼痛,减少术后并发症。

Objective To evaluate the effect of thoracic paravertebral block（ TPVB） by ultrasonic guidance combined with general anaesthesia in partial hepatectomy（ PH）. Methods Eighty patients with hepatocellular carcinoma underwent selective PH were divided into observation group and control group,forty patients in each group. The patients in control group were performed with general anaesthesia by laryngeal mask airway,the patients in control group were performed with TPVB by ultrasonic guidance combined with general anaesthesia. The detention time in post-anesthctic intensive care unit（ PACU）,dosage of sufentanil during the operation and PACU observation,the number of patients with pain visual analogue scales（ VAS） 4 during the 48 hours after operation,the number of patient controlled intravenous analgesia（ PCIA） within 48 hours after operation and postoperative complications were observed in the two groups. Results There was no significant difference in the operation time,intraoperative bleeding,fluid infusion volume and urine volume between the two groups（ P〈0. 05）. There was no significant difference in the mean arterial pressure（ MAP）,heart rate（ HR）,arterial oxygen saturation（ Spo2） and body temperature between the two groups at the time points of preoperation,skin incision and 30 minutes in the operation（ P〈0. 05）.The MAP and HR of patients in observation group were significantly lower than those in control group after laryngeal mask exelcymosis and the Aldrete score reaching the standard of leaving the recovery room（ P〈0. 05）. But there was no significant difference in Spo2 and body temperature between the two groups（ P〈0. 05）. The detention time in PACU of patients in observation group was significantly shorter than that in control group（ P〈0. 01）. The dosage of sufentanil during the operation and PACU observation in observation group was significantly less than that in control group（ P〈0. 01）. The number of patients with pain VAS 4 in observation group was significantly less than that in control group at the time points of 1 hour,6 and 12 hours after operation（ P〈0. 05）. The number of PCIA in observation group was significantly less than that in control group during 0- 1, 1- 6, 6- 12, 12- 24 and 0- 48 h after operation（ P〈0. 05,P〈0. 01）. The rates of postoperative nausea,vomiting and respiratory depression in observation group were significantly lower than those in control group（ P〈0. 05）.Conclusion TPVB by ultrasonic guidance combined with general anaesthesia by laryngeal mask in PH can reduce the intraoperative and postoperative dosage of opioid drugs,shorten the detention time in PACU,relieve postoperative pain of patients and reduce postoperative complications.