超声引导下胸椎旁阻滞联合全身麻醉对减重手术患者的影响

Effect of Ultrasound-Guided Thoracic Paravertebral Block Combined with General Anesthesia in Patients Undergoing Weight Loss Surgery

目的探讨超声引导下胸椎旁阻滞联合全身麻醉应用于减重手术中的临床效果。方法前瞻性纳入2020年6月至2023年8月在郑州大学附属郑州中心医院择期行腹腔镜胃袖状切除术的80例患者,随机数字表法分为两组,各40例。对照组进行静吸复合全身麻醉,观察组在对照组基础上加超声引导下胸椎旁阻滞。比较两组患者入室时(T_(0))、切皮时(T_(1))、术毕时(T_(2))应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)]及血流动力学[心率(HR)、平均动脉压(MAP)];术后6、12、24 h时疼痛程度[采用视觉模拟评分法(VAS)]评估。记录术后72 h内麻醉相关并发症发生情况。结果整体分析应激反应、血流动力学:组间、时间及交互效应有统计学意义(P<0.05)。组内比较:两组T_(1)、T_(2)时E、NE、HR、MAP较T_(0)升高,T_(2)较T_(1)升高(P<0.05)。组间比较:观察组T_(1)、T_(2)时E、NE、HR、MAP均低于对照组(P<0.05)。整体分析术后疼痛:组间、时间及交互效应有统计学意义(P<0.05)。组内比较:两组术后12、24 h时VAS评分较术后6 h升高,术后24 h较12 h升高(P<0.05)。组间比较:观察组术后各时点VAS评分均低于对照组(P<0.05)。观察组麻醉相关并发症总发生率低于对照组(P<0.05)。结论超声引导下胸椎旁阻滞联合全身麻醉可减轻减重手术患者应激反应,维持血流动力学稳定,提高镇痛效果,降低全麻术后并发症发生率。

Objective To explore the clinical effect of ultrasound-guided thoracic paravertebral block combined with general anesthesia in weight loss surgery.Methods A prospective study included 80 patients who underwent laparoscopic gastric sleeve resection at Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2020 to August 2023.They were randomly divided into two groups using a random number table method,with 40 patients in each group.The control group received intravenous inhalation combined to general anesthesia,while the observation group received ultrasound-guided thoracic paravertebral block in addition to the control group.Stress response indicators[adrenaline(E),norepinephrine(NE)]and hemodynamics[heart rate(HR),mean arterial pressure(MAP)]were compared between two groups of patients at entry(T_(0)),skin incision(T_(1)),and postoperative(T_(2)).Pain severity was evaluated using visual analogue scale(VAS)at 6,12,and 24 hours after surgery.The occurrence of anesthesia related complications within 72 hours after surgery were recorded.Results The overall analysis of stress response and hemodynamics showed differences in inter group,time point and interaction effects(P<0.05).Intragroup comparison:E,NE,HR,and MAP of the two groups increased compared to T_(0) at T_(1) and T_(2),while T_(2) increased compared to T_(1)(P<0.05).Inter group comparison:the E,NE,HR,and MAP of the observation group at T_(1) and T_(2) were lower than those of the control group(P<0.05).Overall analysis of postoperative pain:there were differences in inter group,time point and interaction effects(P<0.05).Intragroup comparison:the VAS scores of the two groups increased at 12 and 24 hours postoperatively compared to 6 hours postoperatively,and increased at 24 hours postoperatively compared to 12 hours postoperatively(P<0.05).Inter group comparison:the VAS scores of the observation group were lower than those of the control group at all time points after surgery(P<0.05).The total incidence of anesthesia related complications in the observation group was lower than that in the control group(P<0.05).Conclusion Ultrasound guided thoracic paravertebral block combined with general anesthesia can reduce stress response,maintain hemodynamic stability,improve analgesic effect,and reduce the incidence of postoperative complications in patients undergoing weight loss surgery.