超声引导下胸椎旁神经阻滞复合全身麻醉对行胸腔镜肺叶切除术患者应激反应的影响

Effect of ultrasound-guided paraspinal nerve block combined with general anesthesia on stress response during thoracoscopic lobectomy

目的 探讨分析超声引导下胸椎旁神经阻滞复合全身麻醉对胸腔镜肺叶切除术应激反应的影响。方法将2019年6月-2020年9月期间南通大学附属建湖医院收治的60例胸腔镜肺叶切除术患者纳入本次研究,按照随机数字表法均分为2组,各30例。对照组实施常规全身麻醉,观察组采用超声引导下胸椎旁神经阻滞复合全身麻醉,对比2组患者不同观察时点的生命体征变化,评估术后不同时点2组患者在安静状态和咳嗽状态下的VAS评分,统计术后不良反应情况。结果 与对照组相比,观察组患者T2、T3时点的平均动脉压与心率明显更低,差异具有统计学意义(P<0.05);与对照组相比,观察组患者术后6 h、12 h时在安静状态和咳嗽状态下的VAS评分明显更低,差异具有统计学意义(P<0.05);术后24 h时观察组患者咳嗽状态下的VAS评分明显优于对照组(P<0.05)。观察组患者术后恶心呕吐、眩晕干呕、嗜睡以及躁动等不良反应发生率为3.33%,明显低于对照组的30.00%,差异具有统计学意义(P<0.05)。结论胸腔镜肺叶切除术采用超声引导下胸椎旁神经阻滞+全身麻醉方案可准确定位,取得满意的镇痛效果,降低术后并发症及不良反应,缓解因炎症或者伤害性刺激而引起的应激反应。

Objective To investigate and analyze the effect of ultrasound-guided paravertebral nerve block combined with general anesthesia on the stress response of thoracoscopic lobectomy.Methods Sixty patients undergoing thoracoscopic lobectomy in our hospital from June 2019 to September 2020 were included in this study.They were divided into two groups according to the random number table method,each with 30 cases.The control group performed routine whole body Anesthesia,the observation group used ultrasound-guided paravertebral nerve block combined with general anesthesia to compare the vital signs changes of the two groups of patients at different observation points,and evaluate the VAS of the two groups of patients in the quiet state and cough state at different points after the operation Score,count the postoperative adverse reactions and make statistical analysis.Results Compared with the control group,the average arterial pressure and heart rate at T2 and T3 in the observation group were significantly lower,and the difference between the two groups was statistically significant(P<0.05);Compared with the control group,the observation group had significantly lower VAS scores at 6h and 12h after the operation in the quiet state and cough state,and the difference between the groups was statistically significant(P<0.05);The VAS score of the observation group was significantly better than that of the control group(P<0.05)at 24 hours after operation.The incidence of postoperative nausea and vomiting,dizziness,retching,drowsiness,and restlessness in the observation group was 3.33%,which was significantly lower than 30.00%in the control group.The difference between the two groups was statistically significant(P<0.05).Conclusion Thoracoscopic lobectomy adopts ultrasound-guided paraspinal nerve block+general anesthesia,which can accurately locate,achieve satisfactory analgesia,reduce postoperative complications and adverse reactions,and relieve stress caused by inflammation or noxious stimulation reaction.