异丙酚复合瑞芬太尼联合超声引导下胸椎旁神经阻滞在老年肺癌改良根治术中的应用效果

Effect of propofol combined with remifentanil under ultrasound guided thoracic paravertebral nerve block in modified radical resection of lung cancer in the elderly

目的探讨全身麻醉联合超声引导下椎旁神经阻滞在胸腔镜下肺癌根治术中的应用效果。方法选取该院2017年2月至2019年2月确诊为肺癌并行胸腔镜下肺癌根治术的患者80例,按随机数字表法分为对照组和观察组,各40例,两组全身麻醉方法相同,麻醉维持均采用异丙酚复合瑞芬太尼静脉滴注,观察组于全身麻醉诱导前行椎旁神经阻滞。比较两组术中麻醉药物、血管活性药物用量;记录拔管时间、麻醉恢复室(PACU)停留时间;记录术后视觉模拟量表(VAS)疼痛评分;测试患者术前1 d和术后7 d简易智力状态检查量表(MMSE)评分;记录术后住院时间和术后7 d的不良反应发生情况。结果与对照组比较,观察组术中异丙酚、瑞芬太尼、舒芬太尼、去甲肾上腺素用量减少,拔管时间缩短,PACU躁动发生率降低,差异有统计学意义(P<0.05);观察组PACU内舒芬太尼和异丙酚用量减少,PACU停留时间和住院时间缩短,差异有统计学意义(P<0.05);观察组苏醒时、出PACU时、术后12 h和术后24 h VAS评分降低,术后3 d MMSE评分降低,差异有统计学意义(P<0.05)。结论异丙酚复合瑞芬太尼联合超声引导下胸椎旁神经阻滞可减少患者麻醉药物用量,比单纯全身麻醉具有更好的麻醉效果。

Objective To explore the effect of general anesthesia combined with ultrasound-guided paravertebral nerve block in thoracoscopic radical resection of lung cancer.Methods A total of 80 patients who were diagnosed with lung cancer and underwent thoracoscopic radical resection of lung cancer in this hospital from February 2017 to February 2019 were selected.All patients were divided into the control group and the observation group,according to the random number table method,with 40 cases in each group.The methods of general anesthesia were the same in the two groups,and propofol combined with remifentanil was administered intravenously for maintenance of anesthesia.The observation group received paravertebral nerve block before general anesthesia induction.The dosages of intraoperative anesthetic drugs and vasoactive drugs were compared.The tube extraction time andlength of stay in the post-anesthesia care unit(PACU),and postoperative visual analog scale(VAS)pain scores were recorded.The scores of the Mini-Mental State Examination Scale(MMSE)were measured at 1 d before and 7 d after operation.The postoperative hospital stay and adverse reactions at 7 d after operation were recorded.Results Compared with the control group,the dosages of propofol,remifentanil,sufentanil,and norepinephrine in the observation group during operation were reduced,the extubation time was shortened,and the incidence of agitation in PACU was reduced,the differences were statistically significant(P<0.05);the dosages of sufentanil and propofol in the PACU of the observation group were reduced,the length of PACU stay and hospital stay were shortened,and the differences were statistically significant(P<0.05);the VAS pain scores in the observation group at the time of awaking,leaving PACU,12 and 24 h after operation were decreased,the MMSE score at 3 d after operation in the observation group was decreased,and differences were statistically significant(P<0.05).Conclusion Propofol combined with remifentanil under ultrasound-guided paravertebral nerve block can reduce the anesthetic dosage in patients,and has a better anesthesia effect than general anesthesia only.