摘要
目的探讨胸椎旁神经阻滞联合全身麻醉对肺叶切除术后患者血清心肌钙蛋白I(CTnI)及心肌酶水平的影响。方法选择2019年5月至2020年2月进行肺叶切除术且麻醉方式为全身麻醉的患者60例,性别不限,年龄18~65岁,ASA分级Ⅰ级或Ⅱ级,随机分为研究组和对照组2组,每组30例。对照组患者采用常规全身麻醉,研究组采用胸椎旁神经阻滞联合全身麻醉。分析2组患者麻醉前,手术完结时,手术后6 h、24 h、48 h的血清CTnI及心肌酶含量。绘制散点图探究平均动脉压与心肌酶及cTnI含量之间的联系。结果研究组Ramsay镇静评分多处于2~3分,镇静效果良好;VAS评分在术后第1天到术后第7天均低于对照组;研究组患者的CK与AST含量在手术结束时和术后6 h均明显低于对照组;LD含量在术后6 h明显低于对照组;cTnI含量在手术结束后的6 h、24 h、48 h都明显低于对照组,差异均有统计学意义(P<0.05)。结论胸椎旁神经阻滞联合全身麻醉相比全身麻醉,能够有效降低肺叶切除术对患者的心肌损害,保障患者在术中的安全性,缩短患者康复时间。
Objective To investigate the effects of thoracic paravertebral nerve block combined with general anesthesia on the serum levels of cardiac troponin I(cTnI) and myocardial enzyme in patients after lobectomy.Methods Sixty patients with ASA grade Ⅰ or Ⅱ who underwent lobectomy under general anesthesia in our hospital from May 2019 to February 2020 were enrolled in the study, who were randomly divided into research group and control group, with 30 cases in each group.The patients in control group were treated by conventional general anesthesia, however, those in research group were treated by thoracic paravertebral nerve block combined with general anesthesia.The serum levels of cTnI and myocardial enzyme before anesthesia, at the end of operation, and at 6h, 24h and 48h after operation were detected, moreover the scatter diagram was drawn to analyze the correlation between mean arterial pressure and serum levels of cTnI as well as myocardial enzyme.Results The Ramsay sedation scores in research group were mostly in 2~3 points, with good sedation effects, and VAS scores at 1~7d after operation in research group were lower than those in control group, moreover, the levels of CK and AST at the end of operation and at 6h after operation in research group were significantly lower than those in control group(P<0.05).In addition the LD levels at 6h after operation and cTnI levels at 6h, 24h, 48h after operation in research group were significantly lower than those in control group(P<0.05).Conclusion Compared with general anesthesia, the thoracic paravertebral nerve block combined with general anesthesia can effectively relieve the myocardial damage of patients undergoing lobectomy, ensure the safety of patients during operation and shorten the recovery time of patients.
作者
许川
刘迪
金星
胡剑
梅宏
XU Chuan;LIU Di;JIN Xing(Department of Thoracic Surgery,Guizhou Provincial People’s Hospital,Guizhou,Guiyang 550002,China)
出处
《河北医药》
CAS
2023年第1期56-59,共4页
Hebei Medical Journal
关键词
胸椎旁神经阻滞
肺叶切除术
心肌损害
全身麻醉
thoracic paravertebral nerve block
pulmonary lobectomy
myocardial damage
general anesthesia
