全身麻醉联合连续椎旁神经阻滞在胸腹腔镜联合食管癌根治术中的应用

Application of general anesthesia combined with continuous paravertebral nerve block in thoracoscopic radical resection of esophageal cancer

目的研究全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术效果。方法选择广东省梅州市人民医院胸外科2016年5月-2017年12月收治食管癌根治术患者90例为研究对象,随机分为3组, A组(n=30)采取气管内插管全身麻醉下完成食管癌根治术,B组(n=30)采取全身麻醉联合硬膜外阻滞下完成手术治疗;C组(n=30)采取全身麻醉联合连续椎旁神经阻滞。比较3组患者不同时间点心率(HR)、平均动脉压(MAP)、术中七氟烷、舒芬太尼用量,苏醒相关指标和不良反应发生率。结果与A组比较,B组患者T_1、T_2、T_3、T_4时刻MAP降低,T_1、T_2、T_3时刻HR降低,差异均有统计学意义(P<0.05);C组患者T_2、T_3时刻MAP降低,T_2时刻HR降低,差异均有统计学意义(P<0.05); B、C组患者七氟烷、舒芬太尼用量、拔管后5 min视觉模拟评分法(VAS)评分均降低,睁眼时间、定向力恢复时间、拔管时间、呼吸恢复时间均缩短,差异均有统计学意义(P<0.05)。3组患者不良反应比较,差异无统计学意义(P>0.05)。结论全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术血流动力学平稳,且可减少麻醉药物用量,应用安全。

Objective To study the effect of general anesthesia combined with continuous paravertebral nerve block in radical esophagectomy.Methods90 patients who admitted to department of thoracic surgery of Meizhou people′s hospital from May 2016 to December 2017 and underwent radical surgery for esophageal carcinoma were enrolled,and they were randomly divided into 3 groups.Endotracheal intubation under general anesthesia to complete the radical resection of esophageal cancer was conducted in Group A(n=30).General anesthesia combined with epidural block to complete the surgical treatment was conducted in Group B(n=30).General anesthesia combined with continuous paravertebral nerve block was conducted in Group C(n=30).Heart rate(HR),mean arterial pressure(MAP),intraoperative sevoflurane and sufentanil dosages,indexes related to recovery and incidence of adverse reactions were compared among the 3 groups at different time points.ResultsMAP of the group C were lower than that of the group A at T2,T3 moments.HR was lower than that of group A T2 time(P<0.05).MAP and HR of the Group B at T1,T2 and T3 moment were lower than group A(P<0.05).The dosage of Sevoflurane and sufentanil of the Group B and group C were lower.VAS scores of the Group B and group C were lower in 5 min after extubation.Awake time,directional force recovery time and extubation time and breathing recovery time of the Group B and group C were shorter(P<0.05).Adverse reactions of three groups were no statistically significant difference(P>0.05).ConclusionGeneral anesthesia combined by the continuous hemodynamic stable nerve block used in esophageal cancer radical,and could reduce the dosage of anesthetic drugs,application security.