椎旁阻滞辅助全身麻醉对食管癌手术循环及术后镇痛的影响

Effect of paravertebral block assisted general anesthesia on circulation and postoperative analgesia in patients with esophagus cancer

目的研究椎旁阻滞辅助全身麻醉对食管癌手术患者循环及术后镇痛的影响。方法选择2014年6月至2016年12月行食管癌根治术患者80例,ASA分级Ⅰ级或Ⅱ级,依入院先后顺序分为两组:椎旁阻滞辅助全身麻醉组(n=40,Ⅰ_组),硬膜外阻滞辅助全身麻醉组(n=40,Ⅱ组)。观察两组患者入室静息状态(T0)、阻滞后5 min(T1)、全身麻醉诱导气管插管后(T2)、单肺通气后30 min(T_3)、体位变成侧卧位后(T_4)和手术结束气管内拔管前(T_5)的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP);于术毕缝皮时连接患者自控静脉镇痛泵(PCIA),记录术后不同时间点的疼痛视觉模拟评分(VAS)、术后PCIA总按压次数及不良反应的出现情况。结果组内对比,与T0时点比较,两组MAP值在T1~T_4时均显著降低(P<0.05),CVP值在T_5时点差异有统计学意义(P<0.05);组间对比,在T2、T_3时间点,MAP值差异有统计学意义(P=0.000,P=0.036);在T_3点,CVP值差异有统计学意义(P=0.026);在T_4、T_5时点,HR值有明显波动(P=0.042,P=0.005)。在术后1~6 h阶段,组间比较差异有统计学意义(P=0.004)。结论对于食管癌手术患者,选择椎旁阻滞辅助全身麻醉可以在围术期保持良好的循环稳定,同时术后又可达到有效镇痛。

Objective To investigate the effect of paravertebral block assisted general anesthesia on circulation and postoperative analgesia in patients with esophagus cancer. Methods A total of 80 patients with esophagus cancer,ASA gradeⅠorⅡdegree,from June 2014 to December 2016,were randomly divided into two groups according to the simply randomized method： paravertebral block assisted general anesthesia group（ group Ⅰ） and epidural block assisted general anesthesia group（ group Ⅱ）,with 40 cases in each group. The heart rate,mean arterial pressure and central venous pressure of the two groups in different time points were observed. Patient-controlled intravenous analgesia were connected with patients in the end of surgery immediately,the visual analogue scale of postoperative different time points were recorded. The number of PCIA total pressure and the adverse reactions were recorded. Results Within groups,compared with T0,MAP was significantly decreased at T1-T4（ all P〈0. 05）; and CVP was significantly increased at T5. Between the groups,MAP at T2 and T3,CVP at T3 were significantly different（ P = 0. 000,P = 0. 036,P = 0. 026）. HR were significantly fluctuated at T4,T5（ P = 0. 042, P = 0. 005）. Analgesia at 1-6 h postoperative were significantly different（ P = 0. 004）.Conclusions Paravertebral block assisted general anesthesia facilitates the stable of circulation in patients with esophagus cancer,in addition to reducing the analgesia perception.