摘要
目的 探讨双侧胸椎旁神经阻滞复合全麻在非体外循环冠状动脉搭桥术（OPCABG）应用的效果.方法 择期拟行OPCABG患者60例,年龄50～75岁,体重56～85 kg,ASAⅡ或Ⅲ级.采用随机数字表法将患者均分为两组：双侧胸椎旁神经阻滞复合全麻组（P组）和单纯全麻组（G组）.P组患者麻醉诱导前经T3～4间隙行双侧胸椎旁间隙穿刺置管,两侧分别注射试验剂量0.375％罗哌卡因5 ml,5 min后分别给予首次量0.375％罗哌卡因15ml,然后分别持续泵入0.375％罗哌卡因5 ml/h.P组测定阻滞平面后,两组患者均置入漂浮导管后行全麻诱导.记录芬太尼用量、P组患者痛觉阻滞平面;记录置入漂浮导管后（Ta）、开胸骨后（Tb）、血管桥吻合完毕（Tc）和术毕（Td）的HR、MAP、CVP、平均肺动脉压（MPAP）、心脏指数（CI）、肺动脉阻塞压（PAOP）、体循环阻力指数（SVRI）和肺循环阻力指数（PVRI）;记录术中窦性心动过缓、窦性心动过速、低血压和高血压的发生率以评价循环的稳定性;记录患者术后ICU滞留时间、术后并发症及不良反应.结果 P组患者痛觉阻滞平面T（5.2±0.8）节段,P组芬太尼用量明显低于G组（P＜0.05）;Tc、Td时P组患者CVP、SVRI和PVRI明显低于G组,Td时CI明显高于G组（P＜0.05）;P组患者窦性心动过速和高血压的发生率明显低于G组（P＜0.05）;P组患者术后拔管时间和ICU滞留时间明显短于G组（P＜0.05）;两组术后并发症及不良反应发生率差异无统计学意义.结论 双侧胸椎旁阻滞复合全麻可安全、有效地应用于OPCABG,镇痛完善,循环稳定.
Objective To investigate the feasibility of bilateral thoracic paravertebral block combined with general anesthesia in patients undergoing off-pump coronary artery bypass grafting （OPCABG）.Methods Sixty patients,aged 50-75 y,weighing 56-85 kg,ASA Ⅱ or lⅢ,scheduled for OPCABG,were randomly divided into two groups（n =30 each）：bilateral thoracic paravertebral block combined with general anesthesia group （group P） and pure general anesthesia group（group G）.For patients in group P,bilateral thoracic paravertebral block and insertion epidural catheter were performed at T3-4 interspace prior to induction of anesthesia.A test dose of 5 ml of 0.375％ ropivacacine was injected through the catheter in two sides; 5 mins later,an initial dose of 15 ml of 0.375％ ropivacacine was injected; followed by an infusion of 0.375％ ropivacacine at the rate of 5 ml/h.Consumption of fentanyl in both groups and dermatomes of hypoalgesia in group P were recorded.The parameters of hemodynamics were measured after Swan-Ganz catheterization （Ta）,sternotomy（Tb）,anastomosis of graft vessel （Tc） and at the end of operation（Td）.The stability of circulation was evaluated.Residence time in ICU,complications and side effects after operation were recorded.Results Dermatomes of hypoalgesia was （5.2±0.8） segments in group P.Consumption of fentanyl in group P was significantly lower than that in group G（P＜0.05）.Compared with group G,CVP,SVRI and PVRI at Tc,Td were significantly lower （P＜0.05）and CI was significantly higher at Td in group P.The incidences of sinus tachycardia and hypertension in group P were significantly reduced than in group G（P＜0.05）.Compared with group G,extubation time and residence time in ICU were shortened significantly in group P （P＜ 0.05）.There were no significant differences in complications and side effects after operation between the two groups.Conclusion Bilateral thoracic paravertebral block combined with general anesthesia could be used safely and efficiently in OPCABG with high-quality analgesia and stable circulation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第3期213-216,共4页
Journal of Clinical Anesthesiology
基金
青岛市医药科研指导计划(2011-WSZD035)
关键词
胸椎旁神经阻滞
全身麻醉
冠状动脉搭桥术
Thoracic paravertebral block
General anesthesia
Coronary artery bypass
