摘要
目的探讨并比较超声引导下胸椎旁神经阻滞(thoracic paravertebral nerve block,TPVB)复合全身麻醉与单纯全身麻醉在胸腔镜手术中的临床应用效果。方法选取2022年1月—2024年1月于东南大学附属中大医院溧水分院接受胸腔镜手术的患者62例,采用随机数字表法分为对照组(n=31)和观察组(n=31),对照组接受单纯全身麻醉,观察组在此基础上联合超声引导下TPVB。比较2组患者的术后不同时间点的动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)、视觉模拟评分(visual analogue scale,VAS)、术后24 h皮质醇(cortisol,COR)、术后24 h促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、术后24 h去甲肾上腺素(norepinephrine,NE)和术后不良反应发生率。结果观察组患者的术后2 h MAP为(96.42±5.57)mmHg,低于对照组的(105.69±6.76)mmHg,观察组患者的术后2 h HR(85.43±5.60)次/min,低于对照组的(93.24±5.45)次/min,差异均有统计学意义(P<0.001)。术后2 h,观察组在咳嗽与静息状态下的VAS评分低于对照组;术后12 h,观察组在咳嗽与静息状态下的VAS评分均低于对照组,差异均有统计学意义(P<0.001)。术后24 h,观察组患者的COR、ACTH、NE水平均低于对照组,差异有统计学意义(P<0.001)。观察组患者的不良反应总发生率为0,低于对照组的19.35%,差异有统计学意义(P<0.05)。结论超声引导下TPVB复合全身麻醉应用于胸腔镜手术,能有效维持术后血流动力学稳定,显著减轻术后疼痛与应激反应,且不良反应少,安全性高,是一种有效的复合麻醉方案。
Objective To investigate and compare the clinical efficacy of ultrasound-guided thoracic paravertebral nerve block(TPVB)combined with general anesthesia versus general anesthesia alone in thoracoscopic surgery.Methods A total of 62 patients undergoing thoracoscopic surgery at the Lishui Branch,Zhongda Hospital Affiliated to Southeast University,from January 2022 to January 2024,were randomly divided into a control group(n=31)and an observation group(n=31)using a random number table method.The control group received general anesthesia alone,while the observation group received ultrasound-guided TPVB in addition to general anesthesia.The mean arterial pressure(MAP)and heart rate(HR)at different postoperative time points,visual analogue scale(VAS)scores,postoperative 24-hour cortisol(COR),adrenocorticotropic hormone(ACTH),norepinephrine(NE)levels,and the incidence of postoperative adverse reactions were compared between the two groups.Results At 2 hours post-surgery,the MAP in the observation group was(96.42±5.57)mmHg,which was significantly lower than that in the control group[(105.69±6.76)mmHg](P<0.001).Similarly,the HR in the observation group at 2 hours post-surgery was(85.43±5.60)beats/min,significantly lower than that in the control group[(93.24±5.45)beats/min](P<0.001).At both 2 hours and 12 hours post-surgery,the VAS scores for both coughing and resting states were significantly lower in the observation group compared to the control group(P<0.001).At 24 hours post-surgery,COR,ACTH,and NE levels in the observation group were significantly lower than those in the control group(P<0.001).The total incidence of adverse reactions in the observation group was 0%,which was significantly lower than 19.35%in the control group(P<0.05).Conclusion The application of ultrasound-guided TPVB combined with general anesthesia in thoracoscopic surgery can effectively maintain postoperative hemodynamic stability,significantly reduce postoperative pain and stress responses,and is associated with fewer adverse reactions,demonstrating high safety.It is an effective combined anesthesia regimen.
作者
余定华
许建峰
丰陈
徐佳佳
YU Dinghua;XU Jianfeng;FENG Chen;Xu Jiajia(Department of Anesthesiology,Lishui Branch,Zhongda Hospital Affiliated to Southeast University,Nanjing Jiangsu 211200,China;Department of Anesthesiology,Nanjing Central Hospital,Nanjing Jiangsu 210018,China)
出处
《中国卫生标准管理》
2025年第13期125-128,共4页
China Health Standard Management
关键词
超声引导
胸椎旁神经阻滞
胸腔镜手术
血流动力学
应激反应
不良反应
ultrasound guidance
thoracic paravertebral block
thoracoscopic surgery
hemodynamics
stress response
adverse reactions
