胸椎旁神经阻滞联合静脉全身麻醉在腔镜食管癌根治术中的应用效果

Application of thoracic paravertebral block combined with venous general anesthesia in endoscopic esophagectomy

目的探讨胸椎旁神经阻滞联合静脉全身麻醉在腔镜食管癌根治术中的应用效果。方法抽取2018年1月至2019年1月于郑州大学附属肿瘤医院接受治疗的食管癌患者80例,采用随机数字表法分为联合组和对照组,每组40例。所有患者接受腔镜食管癌根治术,对照组给予静脉全身麻醉,联合组在此基础上实施胸椎旁神经阻滞。比较两组患者手术一般情况、免疫功能和视觉模拟评分法(VAS)评分、匹兹堡睡眠质量指数表(PSQI)评分。结果联合组平均动脉压、心率小于对照组,舒芬太尼用量低于对照组(P<0.05);两组手术时间和术中出血量比较差异未见统计学意义(P>0.05);术前,两组CD3^(+)、CD4^(+)及自然杀伤细胞(NK)细胞水平比较差异未见统计学意义(P>0.05),术后,两组CD3^(+)、CD4^(+)及NK细胞水平较本组术前下降,联合组CD3^(+)、CD4^(+)及NK水平高于对照组(P<0.05);联合组术后PSQI评分和VAS评分低于对照组(P<0.05)。结论胸椎旁神经阻滞联合静脉全身麻醉在腔镜食管癌根治术中应用,有助于维持患者术中动脉压和心率的稳定,对机体免疫系统影响小,有效缓解术后疼痛,促进睡眠。

Objective To investigate the application effect of thoracic paravertebral block combined with venous general anesthesia in endoscopic esophagectomy.Methods A total of 80 patients with esophageal cancer in Cancer Hospital Affiliated to Zhengzhou University from January 2018 to January 2019 were enrolled,and to divided into two groups by random number table methods,with 40 cases in each group.Control group received intravenous general anesthesia,while combination group received intravenous general anesthesia combined with thoracic paravertebral block.Then various indexes were compared between the two groups,including operation indexes,immune function,scores of Visual Analogue Scale(VAS)and Pittsburgh Sleep Quality Index(PSQI).Results The mean arterial pressure and heart rate of combination group were lower than those of control group,and the dosage of sufentanil was lower than that of control group,with statistically significant differences(P<0.05).There was no significant difference between groups in operation time and intraoperative blood loss(P>0.05).Levels of CD3+,CD4+and natural killer cell(NK)cells had no significant difference between groups before operation(P>0.05),and were decreased in both groups after operation,and were higher in combination group than in control group(P<0.05).Postoperative scores of VAS and PSQI in combination group were lower than those in control group(P<0.05).Conclusions The application of thoracic paravertebral block combined with venous general anesthesia in radical resection of esophageal carcinoma can maintain stable the arterial prssure and heart rate of patients durong operation,protect the immune function of patients,effectively relieve postoperative pain,promote sleep.