超声引导下竖脊肌平面阻滞联合全麻对开胸手术患者炎性反应和血流动力学的影响

Influence of erector spinae block under ultrasound-guidance combined with general anesthesia on inflammatory reaction and hemodynamics of patients with thoracotomy

目的:观察超声引导下竖脊肌平面阻滞(ESP)联合全麻对开胸手术患者炎性反应的影响。方法:将拟行开胸手术的患者60例随机分为竖脊肌平面阻滞(ESP)联合全麻组及单纯全麻组,每组各30例。联合全麻醉组入室后予以超声引导下竖脊肌平面阻滞。观察两组患者在术前及术毕48 h白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和IL-10的差异,观察麻醉开始前(T 0)、手术开始时(T 1)、手术开始1 h(T 2)、术毕时(T 3)、术毕2 h(T 4)平均动脉压(MAP)和心率变化,并比较两组患者术毕2 h、12 h和24 h咳嗽时的VAS评分。结果:联合全麻组术毕48 h的IL-6和TNF-α水平明显低于单纯全麻组(P<0.05),但IL-10水平高于单纯全麻组(P<0.05);联合全麻组术毕2 h、12 h和24 h咳嗽时的VAS评分显著低于单纯全麻组(P<0.05)。结论:超声引导下竖脊肌平面阻滞联合全麻可使开胸手术患者血流动力学更稳定,并降低术后疼痛及炎性反应的程度。

Objective:To observe the effect of ultrasound-guided erector spinae plane block(ESP)combined with general anesthesia on inflammatory response in patients undergoing thoracotomy.Methods:60 patients who underwent thoracotomy were selected and divided into group E(30 cases)and group G(30 cases)with random number table.Patients in group E received ultrasound-guided erector spinae plane block(ESP)combined with general anesthesia and patients in group G received only general anesthesia.The differences of IL-6,TNF-and IL-10 between the two groups were observed before and 48 hours after operationlevels.The mean arterial pressure and heart rate were observed at different time points.The visual analog scale(VAS)score was recorded at 2 h,12 h,24 h and 48 h as coμghing after operation.Results:The levels of IL-6 and TNF-αin the group E were obviously lower than those of group G at 48 h after operation(P<0.05).The level of IL-10 in the group E was obviously higher than that in group G(P<0.05)at 48 h after operation.The VAS scores in the group E at 2 h,12 h and 24 h after operation were significantly lower than those of the group G(P<0.05).Conclusion:Ultrasound-guided erector spinae block combined with general anesthesia can make the hemodynamics more stable in patients undergoing thoracotomy and can reduce the degree of postoperative pain and inflammatory response.