超声引导下胸椎旁神经阻滞在老年肺癌患者开胸手术中的应用

Application of thoracic paravertebral block by Ultrasound-guided in elder thoracic surgery patients with lung cancer

目的 探讨超声引导下胸椎旁神经阻滞联合吸入麻醉在老年肺癌患者开胸手术中的应用.方法 选择ASAⅠ或Ⅱ级择期行肺癌开胸手术老年患者80例,随机分为静吸复合麻醉组（A组）和吸入麻醉联合超声引导下胸椎旁神经阻滞组（B组）.记录入室（T0）,切皮时（T1）,开胸时（T2）,开胸后5 min（T3）、10 min（T4）、30 min（T5）、60 min（T6）,拔管时（T7）的平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）;记录停药后患者麻醉药的用量、自主呼吸恢复时间、吞咽时间、呼之睁眼时间、拔管时间及镇静程度评分（Ramsay）.结果 A、B两组的血压（BP）、MAP、HR、BIS仅在T7时间点比较差异有统计学意义（P〈0.05）,A组患者麻醉药用量明显多于B组;停药后B组围苏醒时间短、躁动发生率低.结论 超声引导下胸椎旁神经阻滞联合吸入麻醉用于老年肺癌患者开胸手术麻醉安全有效,能明显减少术中麻醉药用量,且术后苏醒质量较好.

Objective To investigate the application of thoracic paravertebral block by Ultrasound-guided in elder thoracic surgery patients with lung cancer.Methods Eighty elder thoracic surgery patients with lung cancer（ASA Ⅰor Ⅱ）,scheduled for elective thoracic surgery were randomly divided into two groups： group A with intravenous inhalational anesthesia and group B with thoracic paravertebral block by Ultrasound-guided and inhalation anesthesia.MAP,HR and BIS were recorded when entering the operating room（T0）,beginning of operation（T1）,at 5 min（T2）,10 min（T）,30 min（T4）,60 min（T5） after opening the chest and extubation（T7）.The recovery of independent respiration time,deglutation time,eye opening time upon calling,extubation time,the recovery of orientation force time and the total of anesthesia dosage were recored.Restlessness of extubation was observed.Results There was no significant difference in MAP,HR and BIS between group A and group B except for the time of extubation（P〈0.05）.Compared with group A,the recovery of independent respiration time,deglutation time,eye opening time upon calling,extubation time,the recovery of orientation force time and leaving the operating room time and the total of anesthesia dosage were significantly decreased in group B（P〈0.05）.Restlessness of extubation was significantly better in group B than that in group A（P〈0.05）.Conclusions Application of thoracic paravertebral block by Ultrasound-guided in elder thoracic surgery patients with lung cancer is safe and efficacious,and can reduce the total of anesthesia dosage,and improve postoperative revival quality.