文章摘要
罗哌卡因双侧胸椎旁神经阻滞对心肺转流心脏瓣膜手术后康复的影响
Effect of ropivacaine combined with bilateral thoracic paravertebral nerve block on surgical rehabilitation in cardiopulmonary bypass heart valve surgery
  
DOI：10.12089/jca.2017.12.1178
中文关键词: 胸椎旁神经阻滞  心肺转流  心脏手术  术后康复
英文关键词: Paravertebral nerve block  Cardiopulmonary bypass  Cardiac surgery  Postoperative rehabilitation
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作者单位E-mail
张俊杰 410008,长沙市,中南大学湘雅医院麻醉科  
李曼 410008,长沙市,中南大学湘雅医院麻醉科  
曹亚楠 410008,长沙市,中南大学湘雅医院麻醉科  
代思思 410008,长沙市,中南大学湘雅医院麻醉科  
王锷 410008,长沙市,中南大学湘雅医院麻醉科 ewang324@hotmail.com 
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中文摘要:
      
目的 观察全麻复合罗哌卡因单次双侧胸椎旁神经阻滞(thoracic paravertebral nerve block, TPVB)对心肺转流(cardiopulmonary bypass, CPB)心脏瓣膜手术患者术后康复的影响。
方法 择期行心脏瓣膜手术的患者142例, 男68例, 女74例, ASA Ⅱ或Ⅲ级, 采用随机数字表法分为单纯全麻组(C组, n=69)和全麻复合罗哌卡因双侧TPVB组(P组, n=73)。记录麻醉前、术中、麻醉后的血流动力学参数、舒芬太尼总用量、苏醒时间、术后机械通气时间、血管活性药物使用时间、ICU停留时间、术后住院时间及住院费用等。
结果 与C组比较, P组麻醉过程中心率、血压更为稳定, 术中舒芬太尼总用量明显减少[（130.6±5.0） μg vs (202.8±7.4) μg,P<0.01], 患者苏醒时间[(241.0±15.8) min vs (417.6±38.9) min, P<0.05]、术后机械通气时间[(466.0±22.9) min vs (657.8±49.4) min,P<0.05]及ICU停留时间[(22.1±1.0) h vs (34.1±3.6) h,P<0.05]明显缩短, 住院费用明显降低[（72 360±1 565） 元 vs (78 420±2 094) 元,(P<0.05)]。
结论 全麻复合TPVB麻醉效果优于单纯全麻, 有利于维持术中循环稳定, 减少麻醉镇痛药物用量, 并有利于患者术后早期恢复。
英文摘要:
      
Objective To observe the effect of ropivacaine on bilateral posterior thoracic paravertebral nerve block for cardiopulmonary bypass.
Methods A total of 142 patients undergoing elective cardiac valve surgery, 68 males and 74 females, were randomly divided into two groups: group C (general anesthesia, n=69) and group P (general anesthesia+paraverteral nerve block with ropivacaine, n=73). The changes of hemodynamics, BIS, anesthesia dose and postoperative anesthesia were observed before and after anesthesia, the time of mechanical ventilation, the duration of vasoactive drug support, ICU stay time, length of stay and hospitalization costs were recorded.
Results Compared with group C, heart rate and blood pressure were more stable in group P, and the dosage of sufentanil was less [(130.6±5.0) μg vs (202.8±7.4) μg,P<0.01], the patient was awakened quickly [(241.0±15.8) min vs (417.6±38.9) min, P<0.05], and the time of mechanical ventilation [(466.0±22.9) min vs (657.8±49.4) min,P<0.05] and ICU residence time [(22.1±1.0) h vs (34.1±3.6) h,P<0.05] were shortened, the cost of hospitalization decreased [(72 360±1 565) yuan vs (78 420±2 094) yuan,(P<0.05)].
Conclusion Thoracic paravertebral nerve block anesthesia combined with general anesthesia is better than pure general anesthesia, in terms of maintaining intraoperative circulation stability, reducing the amount of anesthetic analgesic drugs, and early recovery of patients after surgery.
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