连续椎旁神经阻滞对胸腔镜肺叶切除术患者应激反应的影响

Effect of continuous paravertebral nerve block anesthesia on stress responses of patients undergoing video-assisted thoracoscopic lobectomy

目的探讨胸腔镜下肺叶切除术中应用连续椎旁神经阻滞麻醉（PVNB）复合全身麻醉对患者血清皮质醇（Cor）、C反应蛋白（CRP）及视觉疼痛模拟量表（VAS）评分的影响。方法将164例择期行胸腔镜下肺叶切除术患者应用抽签法随机分为PVNB复合全麻（观察组）82例和单纯全麻（对照组）82例，比较两组麻醉前、麻醉诱导插管后、手术切皮后5min及术后拔管患者的心率（HR）、平均动脉压（MAP）变化，麻醉前、术后2、12、24、48h血清Cor、CRP水平及术后2、12、24、48hVAS变化。结果围术期观察组的MAP及HR基本稳定（P＞0.05），而对照组均较术前（T0）显著提高（P＜0.05），两组间比较差异有统计学意义（P＜0.05）；术后2~48h（T4~7），观察组的血清Cor、CRP水平及VAS评分均低于对照组（均P＜0.05）；T7时，观察组的PCA次数及舒芬太尼用量均显著少于对照组（P＜0.05）。结论在胸腔镜下肺叶切除术中应用PVNB复合全麻较单纯全麻能够更好地维持血流动力学的稳定，降低机体应激反应。

Objective To investigate the effect of continuous paravertebral nerve block anesthesia (PVNB) on stress responses of patients undergoing video-assisted thoracoscopic (VATS) lobectomy. Methods One hundred and sixty four patients undergoing VATS lobectomy were randomly assigned to two groups: 82 cases received PVNB combined with general anesthesia (study group) and 82 cases received general anesthesia alone (control group). The heart rate (HR) and mean arterial pressure (MAP) were compared between two groups before anesthesia, after anesthesia induction, 5min after incision and extubation. The serum cortisol (Cor), C-reactive protein (CRP) levels before anesthesia, 2h, 12h, 24h, 48h after operation, and pain visual analogue scale (VAS) at 2h, 12h, 24h, 48h after operation were compared between two groups. Results The MAP and HR were stable during perioperative period in study group (P>0.05), while those were increased significantly in control group (P<0.05), there was significant difference between two groups (P<0.05). The serum Cor, CRP levels and VAS in study group were significantly lower than those in control group 2-48h after operation(P<0.05), the number of PCA and the dosage of sufentanil in study group were significantly lower than those in control group(P<0.05). Conclusion PVNB anesthesia combined with general anesthesia applied in VATS lobectomy can better maintain hemodynamic stability and reduce the stress response of patients.