全麻联合超声引导胸椎旁神经阻滞对食管癌患者血压心率术后苏醒质量及疼痛的影响

Effect of general anesthesia combined with ultrasound-guided thoracic paravertebral nerve block on blood pressure,heart rate,postoperative recovery quality and pain in patients with esophageal cancer

目的探讨全身麻醉联合超声引导胸椎旁神经阻滞对中下段食管癌患者血压、心率、术后苏醒质量及疼痛的影响.方法将86例拟行手术治疗的中下段食管癌患者按麻醉方式不同分为两组,每组43例.观察组采用全身麻醉联合超声引导胸椎旁神经阻滞,对照组采用全身麻醉.统计两组麻醉苏醒质量(自主呼吸恢复时间、睁眼时间、拔管时间、麻醉恢复室停留时间),比较不同时间点两组血流动力学(心率、平均动脉压)变化及疼痛视觉模拟量表评分.结果观察组自主呼吸恢复、睁眼、拔管及麻醉恢复室停留时间显著短于对照组(P<0.01).麻醉给药15 min后、插管后、切皮后5 min、拔管前,观察组心率、平均动脉压较入室时无显著变化(P>0.05),对照组较入室时显著升高(P<0.01),观察组显著低于对照组(P<0.01).静息时及咳嗽时观察组苏醒时、术后1d、术后3d、术后5d疼痛视觉模拟量表评分均显著低于对照组(P<0.01).结论全身麻醉联合超声引导胸椎旁神经阻滞可提高中下段食管癌患者麻醉苏醒质量及镇痛效果,减少对血流动力学的影响.

Objective To observe the effect of general anesthesia combined with ultrasound-guided thoracic paravertebral nerve block on blood pressure,heart rate,postoperative recovery quality and pain in patients with middle and lower esophageal cancer.Methods 86 patients with middle and lower esophageal cancer admitted to our hospital were divided into two groups according to different anesthesia methods,43 cases each.The observation group used general anesthesia combined with ultrasound-guided thoracic paravertebral nerve block,and the control group used general anesthesia.Anaesthesia recovery quality(respiratory recovery time,eye opening time,extubation time,anaesthesia recovery room stay time)of two groups were counted.Changes in hemodynamics(heart rate,mean arterial pressure)and scores of the visual analog scale for pain were compared between the two groups at different time points.Results In the observation group,the time of spontaneous breathing recovery,blinking,extubation and anesthesia recovery room was shorter than that of the control group(P<0.01).The heart rate and mean arterial pressure in the observation group were not significantly changed at T1,T2,T3 and T4 compared to T0(P>0.05).The control group was significantly higher than at T0(P<0.01),and the observation group was significantly lower than the control group(P<0.01).The VAS scores of the observation group at rest,coughing,wake-up,1 d,3 d,and 5 d after surgery were significantly lower than those of the control group(P<0.01).Conclusions General anesthesia combined with ultrasound-guided thoracic paravertebral nerve block can improve the quality and analgesic effect of anesthesia in patients with middle and lower esophageal cancer,and reduce the impact on hemodynamics.