椎旁神经阻滞对行腹腔镜根治术治疗胃癌患者麻醉效果的影响

Effect of paravertebral nerve block on the anesthesia effect in laparoscopic radical surgery for gastric cancer patients

[目的]分析椎旁神经阻滞对行腹腔镜根治术治疗的胃癌患者麻醉效果的影响。[方法]以等距随机抽样法将100例行腹腔镜根治术的胃癌患者分为采取全麻的对照组及采取全麻联合椎旁神经阻滞的复合麻醉组,各50例,对2组麻醉效果进行比较。[结果]复合麻醉组丙泊酚用药量少于对照组,拔管时间、麻醉后监测治疗室停留时间短于对照组,差异有统计学意义(t=122.234、60.204、52.822,P<0.05);2组术前平均动脉压、心率比较差异无统计学意义(t=0.175、0.810,P>0.05),复合麻醉组手术15 min、手术0.5 h、手术1 h平均动脉压及心率均低于对照组,差异有统计学意义(t=13.189、10.835、9.480及8.771、12.840、10.525,P<0.05),手术结束时2组数值相当,差异无统计学意义(t=0.183、1.754,P>0.05);复合麻醉组术后2 h、术后6 h、术后12 h、术后24 h静息状态和活动状态疼痛评分均小于对照组,差异有统计学意义(t=36.836、23.862、26.669、24.800和17.121、14.812、22.974、19.041,P<0.05);插管前2组肾上腺素、去甲肾上腺素比较差异无统计学意义(t=0.131、0.034,P>0.05),插管后即刻、拔管后即刻复合麻醉组变化趋势差异无统计学意义(F=0.124、0.259,P>0.05),对照组均呈显著上升趋势,差异有统计学意义(F=5.897、45.210,P<0.05),组间比较复合麻醉组插管后即刻、拔管后即刻肾上腺素、去甲肾上腺素低于对照组,差异有统计学意义(t=48.334、81.997和6.036、8.851,P<0.05);复合麻醉组不良反应发生率12.00%,低于对照组的30.00%,差异有统计学意义(χ^(2)=9.765,P<0.05)。[结论]椎旁神经阻滞有助于降低行腹腔镜根治术治疗的胃癌患者丙泊酚用量,麻醉效果更佳,值得推广。

[Objective]To analyze the effect of paravertebral nerve block on the anesthesia effect in patients undergoing laparoscopic radical surgery for gastric cancer.[Methods]One hundred cases of gastric cancer treated by laparoscopic radical surgery from June 2018 to June 2019 in our hospital were divided into the control group with general anesthesia and the compound anesthesia group with general anesthesia combined with paravertebral nerve block,with 50 cases in each group.The dosage and anesthetic effect of remifentanil in the two groups were compared.[Results]The dosage of remifentanil and propofol in the combined anesthesia group was less than that in the control group,the time of extubation and the time of stay in the monitoring treatment room after anesthesia were shorter than that in the control group,the difference was statistically significant(t=22.234,60.204,52.822,P<0.05);there was no statistically significant difference in the mean preoperative arterial pressure and heart rate between the two groups(t=0.175,0.810,P>0.05),and the operation time of the combined anesthesia group was 15 minutes.The mean arterial pressure and heart rate at 0.5 h and 1 h after operation were lower than those in the control group(t=13.189,10.835,9.480,8.771,12.840,10.525,P<0.05).The two groups had similar values at the end of operation,but the difference was not statistically significant(t=0.183,1.754,P>0.05).The scores of the two groups were lower than those of the control group(t=36.836,23.862,26.669,24.800,17.121,14.812,22.974,19.041,P<0.05);there was no statistical difference in adrenaline and noradrenaline between the two groups before intubation(t=0.131,0.034,P>0.05),and there was no statistical difference in the change trend of the combined anesthesia group immediately after intubation and extubation(F=0.124,0.259,P>0.05),the difference was statistically significant(F=5.897,45.210,P<0.05).The difference was statistically significant(t=48.334,81.997,6.036,8.851,P<0.05)between the two groups.The incidence of adverse reactions in the combined anesthesia group was 12.00%,lower than that in the control group.The difference was statistically significant(χ^(2)=9.765,P<0.05).[Conclusion]Paravertebral nerve block can help reduce the amount of propofol used in laparoscopic radical surgery for gastric cancer patients.