超声引导下椎旁神经阻滞复合全身麻醉对胸腔镜肺大泡切除术应激反应的影响(1)
[摘要]目的 探討超声引导下胸椎旁神经阻滞复合全身麻醉对胸腔镜肺大泡切除术患者应激反应的影响。方法 选择我院2011年1月～2016年1月收治入院择期行单侧胸腔镜肺大泡切除术的100例患者作为研究对象，按随机数字表法分为观察组和对照组，每组50例。观察组采用超声引导下胸椎旁神经阻滞复合全身麻醉，对照组采用单纯全身麻醉，两组均于术毕行患者自控静脉镇痛。记录两组术后2、6、12、24 h的视觉模拟评分(VAS)，检测麻醉前、手术完毕、术后24 h的血糖、肾上腺素(E)、去甲肾上腺素(NE)及多巴胺(DA)浓度。采用放射免疫法进行测定。结果 观察组术后2、6、12 h的VAS评分均显著低于对照组，差异有统计学意义(P<0.05)。观察组术后6、12、24 h的VAS评分均显著低于术后2 h，术后24 h的VAS评分显著低于术后6、12 h，差异有统计学意义(P<0.05)。对照组术后6、12、24 h的VAS评分均显著低于术后2 h，术后12 h的VAS评分显著低于术后6 h，术后24 h的VAS评分显著低于术后6、12 h，差异有统计学意义(P<0.05)。两组术后24 h的E、血糖、DA、NE水平与麻醉前比较，差异有统计学意义(P<0.05)。两组手术完毕时的E、DA、NE水平与麻醉前比较，差异有统计学意义(P<0.05)。对照组术后24 h的E、血糖、DA、NE水平与手术完毕时比较，差异有统计学意义(P<0.05)。观察组术后24 h的E、血糖、NE水平与手术完毕时比较，差异有统计学意义(P<0.05)。观察组术后24 h的E、血糖、DA、NE水平与对照组比较，差异均有统计学意义(P<0.05)。结论 超声引导下胸椎旁神经阻滞复合全身麻醉对胸腔镜肺大泡切除术患者应激反应影响小，且降低了患者疼痛，提高了患者舒适度。
[关键词]超声检查；神经传导阻滞；胸腔镜检查；肺泡；应激反应；镇痛
[中图分类号] R655.3 [文献标识码] A [文章编号] 1674-4721(2017)07(b)-0134-04
[Abstract]Objective To investigate the influence of ultrasound-guided continuous thoracic paravertebral nerve block combined with general anesthesia on stress response in patients undergoing thoracoscopic resection of bullae.Methods 100 patients who underwent unilateral thoracoscopic bullous resection in our hospital from January 2011 to January 2016 were selected as the objects.The patients were divided into the observation group and the control group according to the method of random number table method，50 cases in each group.The observation group was given ultrasound-guided continuous thoracic spinal nerve block combined general anesthesia，the control group was given only general anesthesia.All patients in the two groups underwent controlled intravenous analgesia.The visual analogue scale (VAS) was recorded at 2，6，12，24 h after operation.The blood glucose，epinephrine (E)，norepinephrine (NE) and dopamine (DA) concentrations were measured before and during anesthesia and at 24 h after operation.Radioimmunoassay was used for the determination.Results The VAS scores of the observation group after operation at 2，6 and 12 h was significantly lower than that of the control group，with significant difference (P<0.05).The VAS scores of the observation group after operation at 6，12 and 24 h was significantly lower than that 2 h after operation，and the VAS score of the observation group at 24 h after operation was significantly lower than that 6 and 12 h after operation，with significant difference (P<0.05).The VAS scores of the control group after operation at 6，12 and 24 h was significantly lower than that after operation at 2 h，the VAS score of the control group at 12 h after operation was significantly lower than that after operation at 6 h，and the VAS score after operation at 24 h of the control group was significantly lower than that after operation at 6 and 12 h，with significant difference (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE of the two groups between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，DA and NE of the two groups between after operation and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE of the control group between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose and NE of the observation group between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE after operation at 24 h between the observation group and the control group (P<0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia under ultrasound guidance has little effect on the stress response of patients undergoing thoracoscopic bullae resection，which also reduces the pain and improves the patient comfort., 百拇医药(徐祝红 邹珉 王良萍)
[关键词]超声检查；神经传导阻滞；胸腔镜检查；肺泡；应激反应；镇痛
[中图分类号] R655.3 [文献标识码] A [文章编号] 1674-4721(2017)07(b)-0134-04
[Abstract]Objective To investigate the influence of ultrasound-guided continuous thoracic paravertebral nerve block combined with general anesthesia on stress response in patients undergoing thoracoscopic resection of bullae.Methods 100 patients who underwent unilateral thoracoscopic bullous resection in our hospital from January 2011 to January 2016 were selected as the objects.The patients were divided into the observation group and the control group according to the method of random number table method，50 cases in each group.The observation group was given ultrasound-guided continuous thoracic spinal nerve block combined general anesthesia，the control group was given only general anesthesia.All patients in the two groups underwent controlled intravenous analgesia.The visual analogue scale (VAS) was recorded at 2，6，12，24 h after operation.The blood glucose，epinephrine (E)，norepinephrine (NE) and dopamine (DA) concentrations were measured before and during anesthesia and at 24 h after operation.Radioimmunoassay was used for the determination.Results The VAS scores of the observation group after operation at 2，6 and 12 h was significantly lower than that of the control group，with significant difference (P<0.05).The VAS scores of the observation group after operation at 6，12 and 24 h was significantly lower than that 2 h after operation，and the VAS score of the observation group at 24 h after operation was significantly lower than that 6 and 12 h after operation，with significant difference (P<0.05).The VAS scores of the control group after operation at 6，12 and 24 h was significantly lower than that after operation at 2 h，the VAS score of the control group at 12 h after operation was significantly lower than that after operation at 6 h，and the VAS score after operation at 24 h of the control group was significantly lower than that after operation at 6 and 12 h，with significant difference (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE of the two groups between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，DA and NE of the two groups between after operation and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE of the control group between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose and NE of the observation group between after operation at 24 h and before anesthesia (P<0.05).There was significant difference in the levels of E，blood glucose，DA and NE after operation at 24 h between the observation group and the control group (P<0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia under ultrasound guidance has little effect on the stress response of patients undergoing thoracoscopic bullae resection，which also reduces the pain and improves the patient comfort., 百拇医药(徐祝红 邹珉 王良萍)