肋间神经阻滞复合全身麻醉对胸腔镜手术患者血流动力学的影响

Effect of intercostal nerve block combined with general anesthesia on hemodynamics in patients undergoing video-assisted thoracoscopic surgery

目的探讨肋间神经阻滞复合全身麻醉(INB)对胸腔镜手术患者血流动力学的影响。方法选择2014年1月-2016年1月该院进行胸腔镜肺叶切除的患者100例,按照完全随机分组原则分为对照组和实验组。对照组患者接受单纯静脉诱导、静-吸复合维持全身麻醉,实验组患者接受INB。分别评估两组患者术后的视觉模拟疼痛得分(VAS)和血流动力学指标的变化,比较治疗前后患者免疫功能变化。其中血流动力学指标包括心率(HR)、收缩压(SBP)和脉搏氧饱和度(Sp O2),免疫功能指标包括血清中T细胞亚群CD4+、CD4+/CD8+含量。结果术后不同时间点实验组患者VAS得分均明显小于对照组患者(P<0.05)。术毕时对照组患者SBP和HR明显高于实验组患者(P<0.05)。治疗后实验组患者的CD4+、CD4+/CD8+均明显高于对照组(P<0.05)。结论 INB可以更好地控制胸腔镜患者术后的心血管反应,减轻对患者免疫功能的抑制,值得临床推广。

Objective To investigate the effect of intercostal nerve block combined with general anesthesia on hemodynamics in patients undergoing video-assisted thoracoscopic surgery. Method From January 2014 to January 2016, 100 patients were selected and divided into control group and experimental group according to the principle of complete random grouping. The patients in control group received general anesthesia with intravenous induction and static-occlusion, and the patients in experimental group received intercostal nerve block compound general anesthesia. The changes of visual analogue pain scores （VAS） and hemodynamics were evaluated in both groups. Changes in immune function before and after treatment were compared. Hemodynamic parameters include heart rate （HR）, systolic blood pressure （SBP） and pulse oxygen saturation （SpO2）. Immune function parameters include serum T cell subsets content. Results The VAS scores of the experimental group were significantly lower than those of the control group at different time points （P 〈 0.05）. The systolic blood pressure and heart rate were significantly higher in the control group than those in the experimental group after the operation （P 〈 0.05）. The CD4＋, CD4＋/CD8＋ levels in the test group were significantly higher than those in the control group （P 〈 0.05）. Conclusion Intercostal nerve block composite anesthesia can better control the thoracoscopic patient＇s cardiovascular response and reduce the immune function inhibition, It is worthy of clinical promotion.