超声下椎旁神经阻滞联合全身麻醉应用于开胸手术的效果及对围术期应激的影响

Evaluation of the effect of paravertebral block combined with general anesthesia on patients with thoracotomy and its effect on perioperative stress

目的探讨超声下椎旁神经阻滞联合全身麻醉对开胸手术患者应用效果评价及对围术期应激的影响。方法选取2016年1月至2018年1月期间70例在本院择期行开胸手术患者作为对象,采用随机分组表法把本次纳入研究患者分为对照组和观察组,对照组予以全身麻醉,观察组予以胸椎旁神经阻滞联合全身麻醉。比较两组患者麻醉期间血流动力学变化、麻醉效果、麻醉恢复情况,麻醉期间应激反应及不良反应发生情况。结果两组患者在诱导1 min、插管1 min、拔管后1 min HR、平均动脉压(MAP)、血氧饱和度(Sa O2)比较差异均无统计学意义(P>0.05)。观察组患者的麻醉效果优于对照组(P<0.05)。与对照组比较,观察组患者术后2、6、12 h VAS评分明显降低(P<0.05)。两组患者在术后即刻肾上腺素、去甲肾上腺素水平低于麻醉前,多巴胺高于麻醉前(P<0.05);术后1 d,观察组和对照组血糖、多巴胺、去甲肾上腺素水平均高于麻醉前(P<0.05),对照组肾上腺素水平高于麻醉前(P<0.05);术后1 d,与对照组比较,观察组肾上腺素、血糖、多巴胺、去甲肾上腺素水平均降低(P<0.05)。观察组和对照组不良反应发生率比较差异无统计学意义(P>0.05)。结论行开胸手术时,采用超声下椎旁神经阻滞联合全身麻醉,可提高手术麻醉效果,具有较好镇痛作用,降低患者术后应激反应,且安全性高。

Objective To evaluate the effect of subtotal paravertebral block combined with general anesthesia on the application of open thoracic surgery and its effect on perioperative stress.Methods From January 2016 to January 2018,70 cases of patients who underwent thoracotomy were studied.According to the simple random method,patients were divided into control group and observation group.The control group was given general anesthesia,and the observation group was given thoracic paravertebral nerve combined with general anesthesia.The changes of hemodynamics,anesthetic effect,anesthesia recovery,stress response and adverse reaction during anesthesia were compared between the two groups.Results There was no significant difference in heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(Sa O2)between the two groups at 1 min after induction,1 min intubation and 1 min after extubation(P>0.05).The anesthetic effect of the patients in the observation group was better than that of the control group(P<0.05).The 2 h,6 h,12 h visual analogue score(VAS)score of patients in the observation group were lower than the control group(P<0.05).The levels of epinephrine and norepinephrine in the two groups were lower than that before anesthesia,and the levels of dopamine were higher than that before anesthesia(P<0.05);1 d after operation,the levels of adrenaline in the control group,blood glucose,dopamine and noradrenaline in the two groups were higher than those before anesthesia(P<0.05);the blood glucose,epinephrine,dopamine,norepinephrine in the observation group after 1 d were lower than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Ultrasound paravertebral block combined with general anesthesia can improve the anesthesia effect,and has better analgesic effect,less postoperative stress response,and high safety.