全身麻醉联合胸椎旁神经阻滞对肾癌腹腔镜切除术患者应激反应和并发症的影响

Effects of Combined Thoracic Paravertebral Nerve Block on Stress Response and Complications in Patients with General Anesthesia Underwent Laparoscopic Resection of Renal Cancer

目的探究全身性的麻醉结合胸椎旁神经阻滞对肾癌腹腔镜切除术患者应激反应和并发症的影响。方法对接受腹腔镜切除术治疗的109例肾癌患者的临床资料进行回顾性分析,根据麻醉方式不同分为对照组(55例)和观察组(54例)。对照组实施全身性的麻醉,观察组则另外结合胸椎旁神经的阻滞。采用视觉模拟评分法(VAS)判定两组患者在术后6 h、12 h、24 h、48 h的疼痛情况;采用酶联免疫吸附法检测血清去甲肾上腺素、肾上腺素、皮质醇、多巴胺水平。比较两组患者的VAS评分、应激反应和术后相关的并发症。结果观察组术后6 h、12 h、24 h、48 h的VAS评分较对照组低(P<0.05)。两组患者术后24 h的血清去甲肾上腺素、肾上腺素、皮质醇、多巴胺水平均升高,且与观察组相比,对照组血清去甲肾上腺素、肾上腺素、皮质醇、多巴胺水平更高(P<0.05)。两组患者的术后并发症发生率比较有明显差异,且对照组高于观察组(25.45%vs 9.25%)(χ^(2)=4.966,P=0.026)。结论与全身性的麻醉相比,对肾癌腹腔镜切除术患者采用胸椎旁神经阻滞结合全身性的麻醉,能够减轻术后疼痛和应激反应,且术后并发症少,安全系数高,有临床推广的价值。

Objective To explore the effects of combined thoracic paravertebral nerve block on stress response and complications in patients with general anesthesia undergoing laparoscopic resection of renal cancer.Methods The clinical data of 109 patients with renal cancer who received laparoscopic resection were retrospectively analyzed,and they were divided into the control group(55 cases)and the observation group(54 cases)according to different anesthesia methods in the data.The control group received general anesthesia,and the observation group received thoracic paravertebral nerve block on the basis of the control group.Visual analogue scale(VAS)was used to estimate the pain status of 2 groups at 6 h,12 h,24 h,and 48 h after operation.Serum norepinephrine,epinephrine,cortisol and dopamine levels were detected by enzyme-linked immunosorbent assay.The VAS score,stress response and postoperative complications were compared between the 2 groups.Results The VAS scores of observation group at 6 h,12 h,24 h,and 48 h after operation were lower than the control group(P<0.05).The levels of serum epinephrine,norepinephrine,cortisol and dopamine in the 2 groups were increased 24h after operation,and compared with the observation group,the serum levels of norepinephrine,epinephrine,cortisol and dopamine in the control group were higher(P<0.05).There was a obvious difference in the incidence of postoperative complications between 2 groups,and the control group was higher than the observation group(25.45%vs 9.25%)(χ2=4.966,P=0.026).Conclusion Compared with general anesthesia,the application of thoracic paravertebral nerve block combined with general anesthesia to patients undergoing laparoscopic resection of renal cancer can reduce postoperative pain and stress response,and has fewer postoperative complications and high safety factor,which has the value of clinical promotion.