超声引导下胸椎旁神经阻滞对开胸手术患者应激反应指标水平、术后镇痛效果的影响

Effects of ultrasound-guided thoracic paravertebral nerve block on stress response indexes levels and postoperative analgesia effect in patients undergoing thoracotomy

目的分析超声引导下胸椎旁神经阻滞对开胸手术患者应激反应指标水平、术后镇痛效果的影响。方法选取2018年11月至2020年11月于我院胸外科行开胸手术的146例患者,根据随机数字表法将其分为对照组和研究组,各73例。对照组接受全身麻醉,研究组接受超声引导下胸椎旁神经阻滞复合全身麻醉。比较两组的应激反应指标水平、术后镇痛效果、麻醉苏醒时间、麻醉不良反应发生情况、认知功能。结果研究组术后2 h的Col、GLU、NE、E、8-iso-PGF2α、AngⅡ水平低于对照组(P<0.05)。研究组术后4、12、24、48 h的VAS评分低于对照组,术后镇痛满意度评分高于对照组,术后48 h内镇痛泵按压次数少于对照组(P<0.05)。研究组的睁眼时间、定位功能恢复时间、完成指令时间、拔管时间短于对照组,麻醉不良反应总发生率低于对照组(P<0.05)。研究组术后6、24 h的MMSE评分高于对照组(P<0.05)。结论超声引导下胸椎旁神经阻滞应用于开胸手术患者中,可减轻应激反应,提高术后镇痛效果,缩短麻醉苏醒时间,降低麻醉不良反应发生率,保护认知功能。

Objective To analyze the effects of ultrasound-guided thoracic paravertebral nerve block on stress response indexes levels and postoperative analgesia effect in patients undergoing thoracotomy.Methods From November 2018 to November 2020,146 patients who underwent thoracotomy in thoracic surgery of our hospital were selected and divided into control group and study group according to random number table method,with 73 cases in each group.The control group received general anesthesia,and the study group received ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.The stress response indexes levels,postoperative analgesia effect,anesthesia recovery time,occurrence of anesthesia adverse reactions,cognitive function of the two groups were compared.Results The Col,GLU,NE,E,8-iso-PGF2αand AngⅡlevels at 2 h after operation in the study group were lower than those in the control group(P<0.05).The VAS score at 4,12,24 and 48 h after operation in the study group were lower than that in the control group,the satisfaction score of postoperative analgesia was higher than that in the control group,and the number of pressing analgesia pump within 48 h after operation was less than that in the control group(P<0.05).The eye opening time,positioning function recovery time,command completion time and extubation time in the study group were shorter than those in the control group,and the total incidence of anesthesia adverse reactions was lower than that in the control group(P<0.05).The MMSE score at 6 and 24 h after operation in the study group were higher than that in the control group(P<0.05).Conclusion The ultrasound-guided thoracic paravertebral nerve block applied in patients undergoing thoracotomy can reduce stress response,improve postoperative analgesia effect,shorten anesthesia recovery time,reduce the incidence of anesthesia adverse reactions and protect cognitive function.