七氟烷合并胸椎旁神经阻滞对食管癌根治术患者血流动力学及麻醉恢复的影响

Effect of thoracic paravertebral nerve block combined with sevoflurane on perioperative hemodynamics and anesthesia recovery in patients with open thoracic esophagectomy

目的探讨超声引导下胸椎旁神经阻滞复合七氟烷对开胸食管癌切除术患者围术期血流动力学及麻醉恢复的影响。方法选择左开胸食管癌切除术患者66例,年龄:45～75岁,体重:45～80 kg。随机分为两组:胸椎旁神经阻滞+七氟烷麻醉组,七氟烷麻醉组。观察并记录麻醉前(T_0)、切皮后5 min(T_1)、开胸(T_2)、开胸5 min(T_3)、开胸10 min(T_4)、开胸20 min(T_5)、开胸30 min(T_6)及开胸60 min(T_7)时的患者心率(HR)、MAP(平均动脉压)、七氟烷吸入浓度及脑电双频指数(BIS)。记录拔管后10 min、拔管后20 min、拔管后30 min、拔管后60 min时HR、MAP及镇静-躁动评分(SAS)和术后并发症情况。结果与B组相比,A组在T_1、T_2、T_3、T_5时的MAP值明显降低,在T_3～T_6时HR降低,在T_2～T_4时BIS值明显降低,在T_1～T_7时七氟烷吸入浓度明显降低,气管拔管后10～30 min时HR、MAP及SAS评分明显降低。结论胸椎旁神经阻滞复合七氟烷麻醉可维持食管癌根治术患者围术期血流动力学稳定,术后更易苏醒,利于麻醉恢复。

Objective To investigate the effect of thoracic paravertebral nerve block combined with sevoflurane on perioperative hemodynamics and anesthesia recovery in patients with open thoracic esophagectomy.Methods Totally 66 patients with open thoracic esophagectomy were selected.Age:45~75 years old,weight:45~80 kg.They were randomly divided into two groups:thoracic paravertebral nerve block combined with sevoflurane anesthesia group(group A,n=33)and sevoflurane anesthesia group(group B,n=33).Record before anesthesia(T0),5 min after skin incision(T1),open chest surgery(T2),5 min thoracotomy(T3),open chest surgery 10 min(T4),open chest surgery20 min(T5),open chest surgery 30 min(T6)and 60 min(T7)patients’heart rate(HR),MAP(mean arterial pressure),sevoflurane inhalation concentration and brain electrical double frequency index(BIS).Record postoperative calm-agitation score(SAS),HR,MAP and postoperative complications at 10 min after extubation,20 min after extubation,30 and 60 min after extubation.Results Compared with group B,the MAP value of group A was significantly lower than that of group B at T1,T2,T3,T5,the HR of group A at T3~T6 was significantly lower than that of group B and BIS value of group A at T2~T4 was significantly decreased than that in group B.The concentration of sevoflurane in group A was decreased significantly at T1~T7 than that in group B,and the scores of HR,MAP and SAS in group A were decreased significantly at 10 min^30 min after tracheal extubation than those in group B.Conclusion Thoracic paravertebral nerve block combined with sevoflurane anesthesia can maintain hemodynamic stability and facilitate anaesthesia recovery in patients undergoing radical resection of esophageal cancer.