硬脊膜外腔阻滞复合迷走神经阻滞对胸腔镜下肺大泡切除术的临床疗效

Clinical effect of epidural block combined with vagus nerve block for thoracoscopic resection of lung bullae

目的观察胸段硬脊膜外腔阻滞复合胸内迷走神经阻滞对胸腔镜下肺大泡切除术患者的临床疗效。方法选择2014年12月—2015年12月间在上海中医药大学附属曙光医院胸外科择期行胸腔镜下单侧肺大泡切除术的患者30例,均行胸段硬脊膜外腔阻滞复合胸内迷走神经阻滞。于手术开始即刻(0min),每隔5min记录1次心率和平均动脉压,直至60min时;记录所有患者的手术时间、麻醉成功率;分别于麻醉前、肺复张前、手术结束时抽取患者桡动脉血行血气分析,检测动脉血氧分压(p_aO_2)和动脉血二氧化碳分压(p_aCO_2);记录麻醉效果,术后随访时了解患者对该麻醉方式的满意度。结果 28例患者于胸段硬脊膜外腔阻滞复合胸内迷走神经阻滞麻醉下顺利完成手术,平均手术时间为(51.32±6.69)min。手术0、5、10、15、20、25、30、35、40、45、50、55、60min时的心率和平均动脉压均在正常生理范围内波动。患者在肺复张前的p_aO_2显著低于麻醉前和手术结束时(P值均<0.05),p_aCO_2显著高于麻醉前和手术结束时(P值均<0.05)。结论胸段硬脊膜外腔阻滞复合胸内迷走神经阻滞麻醉可满足胸腔镜下肺大泡切除术的手术要求,效果确切。

Objective To observe the efficacy of epidural anesthesia combined with vagus nerve block in thoracoscopic resection of lung bullae. Methods Thirty patients scheduled for unilateral thoracoscopic resection of lung bullae under thoracic epidural anesthesia combined with thoracic vagus nerve block between December 2014 and December 2015 were enrolled in this study. At the beginning of the operation （0 min）, heart rate and mean arterial pressure were recorded every 5 min until 60 min. Operation time and the success rate of anesthesia were also recorded. Blood samples from the radial artery were collected before anesthesia, before lung recruitment and at the end of operation, and blood gas indexes were recorded. Arterial oxygen partial pressure （PaO2） and arterial carbon dioxide partial pressure （paCO2） were measured. The satisfaction of patients for anesthesia was investigated during follow up. Results The operation was successfully performed under thoracic epidural block combined with intrathoracic vagal block anesthesia in 28 patients, and the mean operative time was （51.32±6.69） rain. Heart rate and mean arterial pressure fluctuated within normal physiological range during operation, PaO2 before lung recruitment was significantly lower than those before anesthesia and at the end of operation （both P〈0. 05）, while paCO2 before lung recruitment was significantly higher than those before anesthesia and at the end of operation （both P〈0. 05）. Conclusion Epidural anesthesia combined with vagus nerve block can meet the requirements of thoracoscopic resection of lung bullae and exhibits a positive effect.