摘要
目的对比胸椎旁神经阻滞联合新型鼻咽通气道保留自主呼吸的"无管化"麻醉和传统双腔支气管插管静吸复合全麻这两种麻醉方式用于胸腔镜手术的优劣。方法选取2020年1月至2022年5月在湖南省人民医院胸外科收治的48例胸腔镜手术患者,采用随机数字表法分为两组,每组24例。观察组选用胸椎旁神经阻滞联合新型鼻咽通气道保留自主呼吸的"无管化"麻醉方法;对照组选用传统双腔支气管插管静吸复合全麻。对比两种麻醉方式不同时点(插管或神经阻滞完成T0、切皮T1、人工气胸T2、病灶切除T3、关胸T4)的镇静镇痛评分、围手术期血浆皮质醇、去甲肾上腺素和肾上腺素的水平,血流动力学指标和术中阿片类药物用量,以及早期下床活动和住院时间等术后快速恢复的指标。结果观察组在T0、T1、T2、T3、T4时的镇静评分均显著高于对照组,差异有统计学意义(均P<0.05);观察组T2、T3、T4时的镇痛评分显著低于对照组(均P<0.05)。观察组T0、T1、T2、T3、T4的血浆皮质醇、肾上腺素水平低于对照组,差异有统计学意义(均P<0.05);观察组T1、T2、T3、T4的去甲肾上腺素水平均低于对照组(均P<0.05)。观察组T1的心率与对照组比较,差异无统计学意义(P>0.05),而T0、T2、T3、T4时心率均低于对照组(均P<0.05)。观察组术中各时间点的平均动脉压均低于对照组,差异有统计学意义(均P<0.05)。观察组术中阿片类药物的总量显著少于对照组(P<0.05)。观察组术后各时间点静息及运动VAS评分均低于对照组,差异有统计学意义(均P<0.05)。观察组术后恢复下床站立时间、行走时间、肛门排气时间、吹熄打火机时间均显著少于对照组,差异有统计学意义(均P<0.05)。观察组术后恶心呕吐次数、患者自控静脉镇痛(PCIA)按压次数及住院时间均显著少于对照组,差异有统计学意义(均P<0.05)。结论胸椎旁神经阻滞联合新型鼻�
Objective To compare the advantages and disadvantages of thoracic paravertebral nerve block combined with new nasopharyngeal airway preserved spontaneous breathing anesthesia and traditional double-lumen bronchial intubation combined with general anesthesia for thoracoscopic surgery.Methods A total of 48 patients with thoracoscopic surgery admitted to the department of thoracic surgery,Hunan Provincial People′s Hospital from January 2020 to May 2022 were selected and divided into two groups by random number table method,with 24 cases in each group.The observation group was treated with thoracic paravertebral nerve block combined with a new type of nasopharyngeal airway to retain spontaneous breathing;The control group was treated with traditional double-lumen bronchial intubation combined with general anesthesia.The sedation and analgesia scores,perioperative plasma cortisol,norepinephrine and epinephrine levels,hemodynamic indexes,intraoperative opioid dosage at different time points(T0 after intubation or nerve block,skin incision T1,artificial pneumothorax T2,focus resection T3,and chest closure T4),as well as early out of bed activity and length of stay in hospital after operation were compared between the two groups.Results The sedation scores of the observation group at T0,T1,T2,T3,T4 were significantly higher than those of the control group(all P<0.05);The analgesic scores at T2,T3 and T4 in the observation group were significantly lower than those in the control group(all P<0.05).The plasma cortisol and epinephrine levels at T0,T1,T2,T3,T4 in the observation group were lower than those in the control group,and the difference was statistically significant(all P<0.05);The levels of norepinephrine at T1,T2,T3 and T4 in the observation group were lower than those in the control group(all P<0.05).There was no significant difference in heart rate at T1 between the observation group and the control group(P>0.05),but the heart rate at T0,T2,T3,T4 was lower than that in the control group(all P<0.05).The mean art
作者
裴万敏
刘剑
唐轶珣
谭慧玲
刘际童
Pei Wanmin;Liu Jian;Tang Yixun;Tan Huiling;Liu Jitong(Department of Anesthesia,Hunan Provincial People′s Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)
出处
《中国医师杂志》
CAS
2022年第10期1541-1545,1551,共6页
Journal of Chinese Physician
关键词
神经传导阻滞
胸椎
胸腔镜检查
麻醉
全身
Nerve block
Thoracic vertebrae
Thoracoscopy
Anesthesia,general
