腹腔镜根治术治疗胃癌时行椎旁神经阻滞的麻醉效果研究

Study on the anesthetic effect of paravertebral nerve block during laparoscopic radical surgery for gastric cancer

目的 分析胃癌患者实施腹腔镜根治术时采取不同的麻醉方案对其麻醉效果及预后的影响。方法 50例行腹腔镜根治术治疗的胃癌患者,按入院诊疗先后顺序分为参考组与对照组,各25例。对照组行全身麻醉,参考组行全身麻醉+椎旁神经阻滞麻醉。比较两组患者的麻醉情况、手术不同时间段的血氧指标、插管前后的激素水平、不良反应发生情况、麻醉药用量、不同状态的疼痛评分。结果 对照组拔管时间为(25.58±1.42)min,麻醉后监测治疗室停留时间为(58.47±1.58)min;参考组拔管时间为(11.84±1.16)min,麻醉后监测治疗室停留时间为(41.82±1.14)min。参考组拔管时间、麻醉后监测治疗室停留时均短于对照组,差异有统计学意义(P<0.05)。手术15 min,参考组平均动脉压、心率分别为(85.26±1.71)mm Hg(1 mm Hg=0.133 kPa)、(55.85±1.35)次/min,低于对照组的(88.21±1.55)mm Hg、(60.79±0.55)次/min,差异有统计学意义(P<0.05)。术后,两组平均动脉压、心率比较,差异无统计学意义(P>0.05)。插管前,两组肾上腺素、去甲肾上腺素比较,差异无统计学意义(P>0.05);插管后即刻,参考组肾上腺素(72.64±1.25)pmol/L高于对照组的(59.54±1.53)pmol/L,去甲肾上腺素(264.45±0.39)pmol/L低于对照组的(278.77±0.54)pmol/L,差异有统计学意义(P<0.05)。参考组不良反应发生率为4.00%,低于对照组的28.00%,差异有统计学意义(P<0.05)。对照组丙泊酚用量(56±12)mg、瑞芬太尼用量(116±14)μg、舒芬太尼用量(130±12)μg;参考组丙泊酚用量(41±10)mg、瑞芬太尼用量(80±6)μg、舒芬太尼用量(94±10)μg。参考组丙泊酚用量、瑞芬太尼用量、舒芬太尼用量均低于对照组,差异有统计学意义(P<0.05)。插管后即刻,参考组静息状态及咳嗽状态的疼痛评分分别为(1.86±0.32)、(1.45±0.25)分,均低于对照组的(4.63±0.21)、(3.56±0.16)分,差异有统计学意义(P<0.05)。结论 在对胃癌患者行腹腔镜根治术治疗时,为了减少麻醉药物的使用量,降低其对患者的预后影响,需给予椎旁神经阻滞麻醉,在减轻患者术中疼痛感的同时,也加快了患者的预后恢复,值得各级医疗机构的广泛借鉴。

Objective To analyze the impact of different anesthesia schemes on the anesthetic effect and prognosis of patients with laparoscopic radical surgery for gastric cancer.Methods A total of 50 patients with laparoscopic radical surgery for gastric cancer were divided into a reference group and a control group according to the order of admission and treatment,with 25 cases in each group.The control group received general anesthesia,and the reference group received general anesthesia+paravertebral nerve block anesthesia.Both groups were compared in terms of anesthesia,blood oxygen index in different time periods,hormone level before and after intubation,occurrence of adverse reactions,anesthetic dosage and pain score in different states.Results The extubation time in the control group was(25.58±1.42)min,and the duration of stay in monitoring treatment room after anesthesia was(58.47±1.58)min;the extubation time in the reference group was(11.84±1.16)min,and the stay time in the monitoring treatment room after anesthesia was(41.82±1.14)min.The extubation time and the stay time in the monitoring treatment room after anesthesia in the reference group were shorter than those in the control group,and the differences were statistically significant(P<0.05).After 15 min of surgery,the mean arterial pressure and heart rate in the reference group were(85.26±1.71)mm Hg(1 mm Hg=0.133 kPa)and(55.85±1.35)beats/min,which were lower than those of(88.21±1.55)mm Hg and(60.79±0.55)beats/min in the control group,respectively.The difference was statistically significant(P<0.05).After surgery,there was no statistically significant difference in mean arterial pressure and heart rate between the two groups(P>0.05).Before intubation,there was no statistically significant difference in epinephrine and norepinephrine between the two groups(P>0.05).Immediately after intubation,the epinephrine of(72.64±1.25)pmol/L in the reference group was higher than that of(59.54±1.53)pmol/L in the control group,and the norepinephrine of(264.45±0.39)pmol/L was lower than that of(278.77±0.54)pmol/L in the control group.The difference was statistically significant(P<0.05).The incidence of adverse reactions in the reference group was 4.00%,which was lower than that of 28.00%in the control group,and the difference was statistically significant(P<0.05).In the control group,the dosage of propofol was(56±12)mg,the dosage of remifentanil was(116±14)μg,the dosage of sufentanil was(130±12)μg;in the reference group,the dosage of propofol was(41±10)mg,the dosage of remifentanil was(80±6)μg and the dosage of sufentanil was(94±10)μg.The dosage of propofol,remifentanil and sufentanil in the reference group were lower than those in the control group,and the difference was statistically significant(P<0.05).Immediately after intubation,the pain scores in resting state and cough state in the reference group were(1.86±0.32)and(1.45±0.25)points,respectively,which were lower than those of(4.63±0.21)and(3.56±0.16)points in the control group,and the difference was statistically significant(P<0.05).Conclusion Paravertebral nerve block anesthesia is required to reduce the dosage of anesthetic drugs and reduce the impact on the prognosis of patients during laparoscopic radical surgery for gastric cancer,which not only reduces the intraoperative pain of patients,but also speeds up the recovery of patients.It is worthy of extensive reference from medical institutions at all levels.