摘要
目的观察超声引导下胸椎旁神经阻滞对食管癌根治术患者围术期应激反应的影响,探讨胸椎旁神经阻滞麻醉应用于食管癌根治术中的安全性和有效性。方法选择杭州医学院附属人民医院2017年12月—2018年5月择期行食管癌手术的患者60例,根据所用麻醉法分为对照组和观察组,对照组患者采用单纯全身麻醉,观察组患者采用全麻复合胸椎旁神经阻滞。观察比较2组患者术中出血量、手术时间、麻醉恢复时间、拔管时间、麻醉药物用量;麻醉诱导前,气管插管时,手术过程中,手术结束时收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO_2);拔管后即刻、拔管后1、3、6、12、24 h VAS疼痛评分;麻醉诱导前、进胸时、关胸时、术后1 h和24 h外周血血糖、肾上腺素(epinephrine,E)和血清炎症因子白细胞介素-6(interleukin-6,IL-6)、白细胞介素-10(interleukin-10,IL-10)等应激相关血清学指标浓度。结果观察组患者术中出血量、手术时间、麻醉恢复时间、拔管时间、麻醉用量均优于对照组;围手术期SBP、DBP、HR、SpO_2变化稳定;各时间点VAS疼痛评分均低于对照组;各时间点患者外周血血糖、肾上腺素E、IL-6、IL-10均低于对照组。结论超声引导下胸椎旁神经阻滞可提高麻醉效果,减少全麻药用量、抑制食管癌手术患者应激反应、提高术后镇痛效果,值得临床推广。
Objective To observe the effect of ultrasound-guided thoracic paravertebral block （TPVB） on perioperative stress response in patients undergoing radical surgery for esophageal carcinoma, and evaluate the safety and effectiveness of TPVB. Methods Total 60 patients with esophageal carcinoma surgery in People＇ s Hospital of Hangzhou Medical College from December, 2017 to May, 2018 were selected and divided into control group and observation group. The control group was treated with general anesthesia merely, while the observation group was treated with general anesthesia combined with TPVB. The intraoperative blood volume, operative time, anesthesia recovery time, tube drawing time and dosage of anesthetic drugs were compared between the two groups. Systolic blood pressure （SBP） , diastolic blood pressure （DBP）, heart rate （HR）, and oxygen saturation （SpO2 ） were observed before anesthesia induction, endotracheal intubation, during the operation process and after surgery. VAS pain scores were recorded and compared immediately after tube drawing and 1, 3, 5, 12, 24 h later. Before anesthesia induction, entrance the breast, close the breast, 1 h and 2 h after surgery, the concentration of stress-related serological indexes such as peripheral blood sugar, epinephrine （E） , serum inflammatory factor interleukin-6 （ IL-6 ） and interleukin-10 （ IL-10 ） were detected. Results When compared with control group, the intraoperative blood volume, operative time, anesthesia recovery time, tube drawing time and dosage of anesthetic drugs in observation group were superior; the changes of SBP, DBP, HR and SpO2 were stable during perioperative period. The VAS pain score at each time was lower than that in control group. Peripheral blood sugar, epinephrine （E） , IL-6 and IL-10 were lower than that in control group. Conclusion Uhrasound-guided thoracic paravertebral block can improve the anesthetic effect, reduce anesthetic sum, inhibit the stress reaction in patients with esophageal carcinoma surgery and improve analgesic effect after surgery, which is worthy of popularization in clinical application.
作者
吴佳
陈龙
陈悦
钱军
胡双飞
WU Jia;CHEN Long;CHEN Yue(Department of Anesthesiology,Zhejiang Provincial People＇s Hospital,Hangzhou,Zhejiang 310014,China)
出处
《中华全科医学》
2018年第11期1826-1828,1842,共4页
Chinese Journal of General Practice
基金
2017年浙江省医药卫生科研基金(2017KY231)
关键词
食管癌
超声引导
胸椎旁神经阻滞
应激反应
Esophageal carcinoma
Uhrasound-guided
Thoracic paravertebral block
Stress response
