全身麻醉联合双侧胸横肌平面阻滞在非体外循环冠状动脉搭桥手术中的应用效果

Effects of general anesthesia combined with bilateral transversus thoracic plane block on patients undergoing off-pump coronary artery bypass grafting

目的探讨全身麻醉联合双侧胸横肌平面阻滞(TTPB)在非体外循环冠状动脉搭桥手术(OPCAB)中的应用效果。方法回顾性分析2019年6月至2021年6月于临汾市中心医院行OPCAB的67例患者临床资料。67例患者依照麻醉方案分为两组,联合组34例采用全身麻醉联合TTPB麻醉,全麻组33例行单纯全身麻醉。比较两组麻醉诱导前(T0)、切皮劈胸骨(T1)、吻合回旋支远端(T2)、吻合回旋支近端(T3)、关胸时(T4)时间点血流动力学指标[平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、体循环阻力指数(SVRI)、心率(HR)、肺循环阻力指数(PVRI)];T0、T1、T4时间点应激指标[去甲肾上腺素(NE)与皮质醇(Cor)]水平;术中术后舒芬太尼用量;循环稳定性[窦性心动过缓、窦性心动过速、低血压、高血压发生率]以及术后恢复指标[气管导管保留时间和ICU停留时间]。结果两组T0、T1、T2、T3、T4各时间点MAP、HR、CI水平比较均无统计学差异(P均>0.05),联合组T2、T3、T4时间点CVP、SVRI、PVRI水平低于全麻组(P<0.05);两组T0时间点血清Cor、NE水平比较均无统计学差异(P均>0.05);联合组T1、T4时间点血清Cor、NE水平低于全麻组(P<0.05);联合组术中及术后舒芬太尼用量少于全麻组(P<0.05);两组窦性心率过缓、低血压发生率比较均无统计学差异(P均>0.05),联合组窦性心率过速、高血压发生率低于全麻组(P均<0.05);联合组术后气管导管保留时间、ICU停留时间均短于全麻组(P均<0.05)。结论OPCAB中应用全麻联合TTPB可有效稳定患者术中血流动力学波动,减轻术中应激反应,减少术中和术后舒芬太尼用量,降低高血压及窦性心动过速发生率,有利于患者术后早期恢复。

Objective To investigate the effects of general anesthesia combined with bilateral transversus thoracic plane block(TTPB)on patients undergoing off-pump coronary artery bypass grafting(OPCAB).Methods The clinical data of 67 patients who underwent OPCAB in Linfen Central Hospital from June 2019 to June 2021 were retrospectively analyzed.67 patients were divided into two groups according to the anesthesia plan.Thirty-four patients in the combined group received general anesthesia combined with TTPB,and 33 patients in the general anesthesia group received simple general anesthesia.The hemodynamics indexes[mean arterial pressure(MAP),central venous pressure(CVP),heart rate(HR),cardiac index(CI),systemic vascular resistance index(SVRI),pulmonary vascular resistance index(PVRI)]before anesthesia induction(T0),at sternum splitting time(T1),circumflex branch reaching to distal end in anastomosis(T2),circumflex branch reaching to proximal end in anastomosis(T3)and chest closure time(T4),levels of stress indexes[norepinephrine(NE),cortisol(Cor)]at T0,T1 and T4,intraoperative and postoperative dosages of sufentanil,incidence of circulatory stability[sinus bradycardia,sinus tachycardia,hypotension,hypertension]and postoperative recovery indexes[retention time of tracheal tube,stay time in ICU]were compared between the two groups.Results The difference in perioperative MAP,HR and CI between the two groups were not statistically significant(all P>0.05).At T2,T3 and T4,levels of CVP,SVRI and PVRI in the combined group were lower than those in the general anesthesia group(all P<0.05).At T0,difference in levels of serum Cor and NE between the two groups were not statistically significant(all P>0.05).At T1 and T4,levels of serum Cor and NE in the combined group were lower than those in the general anesthesia group(all P<0.05),intraoperative and postoperative dosages of sufentanil were fewer than those in the general anesthesia group(all P<0.05).The difference in incidence of sinus bradycardia and hypotension between the two groups was not statistically significant(all P>0.05).The incidence rates of sinus tachycardia and hypertension in the combined group were lower than those in the general anesthesia group(all P<0.05).The retention time of tracheal tube and stay time in ICU in the combined group were shorter than those in the general anesthesia group(all P<0.05).Conclusions The general anesthesia combined with TTPB in OPCAB patients can effectively stabilize fluctuations of intraoperative hemodynamics,alleviate intraoperative stress response,reduce intraoperative and postoperative dosages of sufentanil,and reduce the incidence of hypertension and sinus tachycardia,which is conducive to postoperative early recovery of patients.