胸椎旁阻滞复合全身麻醉对开胸单肺通气手术镇痛效果分析

Analysis on Analgesia Effect of Thoracic Paravertebral Block Combined with General Anesthesia for Open Chest and Single Lung Ventilation

目的:探讨胸椎旁阻滞与硬膜外阻滞复合全身麻醉对开胸单肺通气手术麻醉及镇痛效果分析。方法:选择我院2016年1月-2018年8月收治的75例行开胸单肺通气手术的肺癌患者,根据随机数字表法,患者分为A组(38例)及B组(37例),A组给予硬膜外阻滞复合全身麻醉,比较两组的麻醉效果、穿刺并发症、术后一周的胸部并发症、术后一周的肺部并发症。结果:A组术后一周肺部并发症发生率、麻醉起效时间、平均麻醉阻滞节段数明显高于B组,P<0.05。两组的丙泊酚及芬太尼用量对比无统计学意义,P>0.05;两组术后6、12、24、48 h静息状态下及术后6 h咳嗽状态下VAS评分对比无统计学意义,P>0.05;B组术后12、24、48 h咳嗽状态下VAS评分明显低于A组,P<0.05。T0-T5点,两组PaO2及PvO2对比无统计学意义,P>0.05;T6点时,A组的PaO2及PvO2明显高于B组,T7点时,A组的PaO2明显高于B组,P<0.05。结论:胸椎旁阻滞复合全身麻醉与硬膜外阻滞复合全身麻醉的麻醉效果相同,术后运动性镇痛效果及术后氧合优于硬膜外阻滞,且术后胸部并发症较少。

Objective To investigate the anesthetic and analgesic effect of thoracic paravertebral block and epidural block combined with general anesthesia for single lung ventilation operation. Methods Totally 75 lung cancer patients undergoing chest open ventilation from Jan. 2016 to Aug. 2017 in our hospital were chosen, and divided into group A (38 cases) and group B (37 cases). The patients in group A were given epidural block combined with general anesthesia, and the patients in group B were given thoracic paravertebral block combined with general anesthesia. The anesthetic effect, puncture complications, thoracic complications one week after operation and pulmonary complications one week after operation were compared between the two groups. Results The pulmonary complications after operation for 1 week, anesthesiaonset time, average blocksaverage number of group A were obvious higher than those of group B (P <0.05). The fentanyl and propofol dosage during general anesthesia of two groups had no significant difference (P >0.05). The VAS score of group B after surgery for 6, 12, 24 and 48 h at rest and after surgery for 6 h at cough state of two groups had no significant difference (P >0.05). The VAS scores of group B after surgery for 12, 24 and 48 h were lower than those of group A (P <0.05). At T0–T5, the PaO2 and PvO2 of two groups had no significant difference (P >0.05), at T6, the PaO2 and PvO2 of group A were higher than those of group B (P <0.05), at T7, the PaO2 of group A was higher than that of group B (P <0.05). Conclusion The anesthetic effect of thoracic paravertebral block and epidural block combined with general anesthesia is comparable. The postoperative exercise analgesia effect and postoperative oxygenation are better than epidural block, and the postoperative pulmonary complications are less.