竖脊肌平面阻滞联合喉罩保留自主呼吸在胸腔镜肺叶切除术麻醉中的应用

Application of Vertical Spinal Muscle Planar Block Combined with Laryngeal Mask Retention for Autonomous Breathing in Thoracoscopic Lung Lobectomy Anesthesia

目的:探讨竖脊肌平面阻滞联合喉罩保留自助呼吸在胸腔镜肺叶切除术麻醉中应用的有效性和安全性。方法:选择我院择期胸腔镜肺叶切除术患者40例,按照随机数字表法将所有患者分为竖脊肌平面阻滞联合喉罩保留自主呼吸麻醉组20例(C组)和双腔管气管插管全麻组20例(S组)。分别于麻醉诱导前(T1)、手术开始后10min(T2)、手术开始后30min(T3)、术毕结束后10min(T4)检测两组患者血中皮质醇、去甲肾上腺素和肾上腺素浓度;记录两组术中呼气末二氧化碳分压最高值(PetCO_2max)和氧饱和度最低值(SpO_2min);比较两组患者的手术时间、苏醒时间、住院时间、术后并发症、疼痛评分和术者满意度。结果:与T1时比较,两组患者在T2、T3、T4时的皮质醇、去甲肾上腺素和肾上腺素的含量均升高(P<0.05);在T2、T3、T4时,C组皮质醇、去甲肾上腺素和肾上腺素的含量均低于相同时间点的S组(P<0.05);与S组比较,C组术中PetCO_2max增加(P <0.05),SpO_2min降低(P <0.05),患者苏醒时间、住院时间均缩短(P <0.05),术后VAS疼痛评分降低(P <0.05),术后咽喉痛、声嘶发生率明显减少(P<0.05);两组手术时间和术者满意度均无差别(P>0.05)。结论:竖脊肌平面阻滞联合喉罩保留自助呼吸应用于胸腔镜肺叶切除术的麻醉具有一定的可行性,不影响手术进程并有效抑制手术应激反应,加快患者康复同时减少并发症。

Objective: To investigate the efficacy and safety of spinal plane block combined with laryngeal mask self-help breathing in anesthesia for thoracoscopic pulmonary lobectomy. Methods: 40 cases of patients with elective thoracoscopic lobectomy in our hospital were selected and randomly divided into the erector spine plane block combined with the laryngeal mask and retained spontaneous breathing anesthesia group (group C) and the double-lumen endotracheal intubation general anesthesia group (group S) with 20 in each.The concentration levels of plasma cortisol,norepinephrine and epinephrine were measured in the two groups before anesthesia induction (T1),10 minutes after the beginning of operation (T2),30 minutes after the beginning of operation (T3) and 10 minutes after the end of operation (T4);The highest PetCO2 (PetCO2 max)and the lowest SpO2 (SpO2 min) were recorded during surgery in the two groups;The operative time,anesthesia recovery time,hospitalization time,postoperative complications,postoperative VAS pain and surgeon’s satisfaction were compared between the two groups.Results: Compared with T1,the levels of cortisol,norepinephrine and epinephrine at T2,T3 and T4 in both groups increased (P <0.05). At T2,T3 and T4,the contents of cortisol,norepinephrine and epinephrine in group C were lower than those in group S at the same time point (P<0.05). Compared with group S,patients in group C experienced increased PetCO2 max (P < 0. 05),decreased SpO2 min (P < 0. 05),shortened anesthesia recovery time and hospitalization time (P < 0. 05),decreased postoperative VAS pain score (P <0.05),and significantly decreased the incidence of postoperative laryngopharyngeal pain and hoarseness (P <0.05).There was no difference in operative time and surgeon’s satisfaction between the two groups (P >0.05).Conclusion: The erector spinae plane block combined with laryngeal mask and retained spontaneous breathing in anesthesia is certain feasible for thoracoscopic lobectomy,which does not affects the surgical process and effectively inhibits the surgical stress response,accelerates patient recovery and reduces complications.