胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者血流动力学和应激反应的影响

Effect of thoracic paravertebral nerve block combined with general anesthesia on hemodynamics and stress response in patients undergoing thoracoscopic radical surgery for lung cancer

目的探讨胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者血流动力学和应激反应的影响。方法将2016年3月～2017年10月90例胸腔镜肺癌根治术患者随机数字表法分组。对照组采用单纯的全身麻醉,观察组采用胸椎旁神经阻滞复合全身麻醉。比较两组胸腔镜肺癌根治术麻醉效果;烦躁等并发症发生率;干预前后患者肾上腺素、皮质醇、血糖水平;舒张压、收缩压、心率水平;术后各时间点的VAS镇痛评分和Ramasy镇静评分。结果观察组胸腔镜肺癌根治术麻醉效果高于对照组,差异有统计学意义(P<0.05);观察组烦躁等并发症发生率低于对照组,差异有统计学意义(P<0.05);麻醉前两组肾上腺素、皮质醇、血糖水平相近(P>0.05);手术开始15min后观察组肾上腺素、皮质醇、血糖水平优于对照组,差异有统计学意义(P<0.05)。观察组舒张压、收缩压、心率水平低于对照组,差异有统计学意义(P<0.05)。观察组术后各时间点的VAS镇痛评分和Ramasy镇静评分优于对照组,差异有统计学意义(P<0.05)。结论胸椎旁神经阻滞复合全身麻醉在胸腔镜肺癌根治术麻醉中的效果确切,可更好维持动力学指标稳定和减少不良反应,提高麻醉的效果,减轻应激反应。

Objective To investigate the effects of thoracic paravertebral nerve block combined with general anesthesia on hemodynamics and stress response in patients undergoing thoracoscopic radical surgery for lung cancer.Methods90patients with thoracoscopic lung cancer radical surgery from March2016to October2017were randomly grouped according to a random number table.The control group underwent simple general anesthesia,and the observation group underwent thoracic paravertebral nerve block combined with general anesthesia.The anesthetic effects of thoracoscopic lung cancer radical surgery,the incidence of complications such as irritability,the levels of adrenaline,cortisol and blood glucose before and after intervention,diastolic blood pressure,systolic blood pressure,heart rate level,VAS analgesia score and Ramasy sedation score at various time points after surgery were compared between the two groups.Results The anesthetic effect of thoracoscopic lung cancer radical operation was higher in the observation group than that in the control group(P<0.05).The incidence of irritations and other complications in the observation group was lower than that in the control group(P<0.05).The two groups had similar adrenaline,cortisol and blood glucose levels before anesthesia(P>0.05).After15minutes of surgery,the levels of adrenaline,cortisol and blood glucose in the observation group were better than the control group(P<0.05).The diastolic blood pressure,systolic blood pressure and heart rate of the observation group were lower than the control group(P<0.05).The VAS analgesia score and Ramasy sedation score of the observation group were better than the control group at each time point(P<0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia is effective in the anesthesia of thoracoscopic lung cancer radical surgery,which can better maintain the stability of kinetic parameters and reduce adverse reactions,improve the effect of anesthesia and reduce the stress response.