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| 全麻联合超声引导下椎旁神经阻滞在胸-腹腔镜食管癌根治术中的应用 |
| Application of general anesthesia combined with ultrasound-guided paravertebral nerve block in patients undergoing thoracoscopic and laparoscopic esophagectomy |
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| DOI：10.12089/jca.2018.06.002 |
| 中文关键词: 椎旁神经阻滞 胸腹腔镜联合食管癌根治术 术后早期疼痛及躁动 术后认知功能障碍 术后快速康复 |
| 英文关键词: Paravertebral nerve block Thoracoscopic and laparoscopic esophagectomy Early postoperative pain and agitation Postoperative cognitive disfunction Postoperative rapid recovery |
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| 中文摘要: |
目的 评估全麻联合超声引导下椎旁神经阻滞(ultrasound-guided paravertebral nerve block, USG-PVB)在胸-腹腔镜食管癌根治术(thoracoscopic and laparoscopic esophagectomy, TLE)中的应用效果。
方法 选择择期行TLE的患者48例, 男40例, 女8例, 年龄52～72岁, BMI 15.1～26.2 kg/m2, ASA Ⅰ或Ⅱ级, 随机分为两组：全麻联合USG-PVB组(P组)和全麻组(G组), 每组24例。两组全麻方法相同, P组于全麻诱导前行椎旁神经阻滞(paravertebral nerve block, PVB)。记录术中麻醉药物、血管活性药物和PACU药物用量;记录拔管时间、PACU停留时间、苏醒期躁动情况;记录苏醒时、出PACU时及术后1、2、3、5 d静息和咳嗽时VAS评分;测试患者术前1 d 和术后7 d简易智力状态检查量表(MMSE)评分;记录术后住院时间和术后7 d POCD发生率。
结果 与G组比较, P组术中丙泊酚、瑞芬太尼、舒芬太尼用量明显减少, 去氧肾上腺素用量明显增多(P<0.05);拔管时间明显缩短, 苏醒期躁动发生率明显降低, PACU舒芬太尼用量明显减少, PACU停留时间和术后住院时间明显缩短(P<0.01或P<0.05);苏醒时、出PACU时和术后1、2、5 d静息和咳嗽时VAS评分、术后3 d咳嗽时VAS评分均明显降低(P<0.01或P<0.05)。术后7 d两组POCD发生率差异无统计学意义。
结论 全麻联合USG-PVB可减少围术期镇痛药物用量, 减轻患者术后早期疼痛及躁动,缩短住院时间, 有利于患者术后快速康复。 |
| 英文摘要: |
Objective To evaluate the effects of general anesthesia combined with paravertebral block guided by ultrasound in patients undergoing thoracoscopic and laparoscopic esophagectomy.
Methods Forty-eight patients accepted thoracoscopic and laparoscopic esophagectomy, 40 males and 8 females, aged 52-72 years, BMI 15.1-26.2 kg/m2, ASA physical status Ⅰ or Ⅱ, were recruited and randomly divided into general anesthesia group (group G, n = 24) and general anesthesia combined with paravertebral block guided by ultrasound group (group P, n = 24). Both group P and group G received the same general anesthesia. Patients in group P received paravertebral block guided by ultrasound before anesthesia induction. Medication including anesthetics and vasoactive agents in operating room and in PACU were calculated. Extubation time, PACU residence time, restlessness in PACU and VAS (visual analogue scale) in quiet and coughing conditions in analepsia, lefting PACU and 1, 2, 3, 5 d after operation were recorded. The mini-mental state examination (MMSE) scores of patients 1 d before surgery and 7 d after surgery were measured. The incidence of postoperative cognitive disfunction (POCD) was recorded. The length of postoperative hospitalization was recorded.
Results Compared to group G, the intraoperative consumption of propofol, ramifentanil and sulfentanyl were significantly decreased in group P, and the consumption of phenylephrine was remarkbly higher in group P (P < 0.05). The extubation time, incidence of postoperative agitation, dose of sulfentanyl used in PACU, PACU stay time and length of postoperative hospitalization were significantly reduced in group P (P < 0.01 or P < 0.05). The VAS scores in quiet and coughing conditions in analepsia, lefting PACU and 1, 2, 5 d after operation and the VAS scores in coughing conditions 3 d after operation were remarkably decreased in group P (P < 0.05). There was no significant difference in POCD incidence between the two groups.
Conclusion The general anesthesia combined with ultrasound-guided paravertebral nerve block can effectively reduce the consumption of perioperative opioid analgesic drugs, relieve the early postoperative pain and agitation of the patients undergoing thoracoscopic and laparoscopic esophagectomy and shorten the hospital stay, thus facilitating the postoperative recovery. |
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