摘要
目的 探讨神经刺激仪引导胸椎旁神经阻滞（thoracic paravertebral nerve block,TPVB）复合全身麻醉在小切口肺癌术中的临床应用价值.方法 选择拟行小切口肺癌手术的患者40例,ASA Ⅰ～Ⅱ级,随机分为胸椎旁神经阻滞复合全麻（P）组和全身麻醉（G）组,每组20例.记录两组麻醉诱导前（T0）,气管插管后（T1）,切皮即刻（T2）,打开胸腔即刻（T3）,单肺通气30 min（T4）,关闭胸腔即刻（T5）,手术结束（T6）各时点平均动脉压（MAP）和心率（HR）.记录两组全身麻醉药的用量.观察两组术毕自主呼吸恢复、拔除气管导管时间及不良反应发生率.观察两组术后2、6、24 h的静息和咳嗽状态下VAS评分.结果 P组血流动力学平稳,在T2～T6各时间点的MAP、HR均低于G组（P＜0.05）.P组术中全身麻醉药的用量低于G组（P＜0.05）.P组自主呼吸恢复、拔除气管导管时间显著短于G组（P＜0.05）;烦躁的发生率明显低于G组（P＜0.05）.P组术后2、6h的静止和咳嗽状态下VAS评分均低于G组（P＜0.05）.结论 神经刺激仪引导胸椎旁神经阻滞复合全身麻醉用于小切口肺癌手术全麻用药量少、苏醒快、术后镇痛时间长、并发症少,是一种值得推广的麻醉方法。
Objective To evaluate the anesthesia efficacy of thoracic paravertebral nerve block by nerve stimulator combined general anaesthesia on small incision lung cancer operation.Methods Forty patients undewent small incision lung cancer operation,ASA Ⅰ-Ⅱ,were randomly divided into two groups,thoracic paravertebral nerve block combined general anaesthesia group （Group P） and anaesthesia group （Group G）,there were 20 cases in each group.MAP and HR of the two groups were monitored at preanesthesia （T0）,post of trachea cannula （T1）,Skin incision （T2）,open the thoracic cavity（T3）,30 min one-lung ventilation（T4）,close the thoracic cavity （T5） and end of operation（T6）.And the general anesthetics dosage of two group were recoreded.In postoperative,spontaneously breathing recover time,extubation time and adverse reaction were recorded.At 2,6,24 h after operation,VAS scores of patients in resting and coughing were recored.Results Hemodynamics of group P was stable.At T2-T6,the MAP and HR of group P were lower than those of group G significantly （P ＜ 0.05）.The general anesthetics dosage of group P was lower than that of group G（P ＜ 0.05）.In postoperative,spontaneously breathing recover time and extubation time of group P were shorter than those of group G （P ＜ 0.05）,Incidence of restlessness in group P was lower than that in group G （P ＜ 0.05）.At In 2 and 6 h after operation,VAS scores of group P patients in resting and coughing were lower than that of group G significantly （P ＜ 0.05）.Conclusions Thoracic paravertebral nerve block by nerve stimulator combined general anaesthesia is safe and effective in small incision lung cancer operation,it is a recommendable method for its lower anesthetics dosage,early recovery,long time of analgesia and fewer adverse reaction.
出处
《中国实用医刊》
2014年第21期8-10,共3页
Chinese Journal of Practical Medicine
关键词
胸椎旁神经阻滞
神经刺激仪
全身麻醉
小切口肺癌手术
Thoracic paravertebral nerve block
Peripheral nerve stimulator
General anaesthesia
Small incision lung cancer operation
