椎旁神经阻滞在开胸手术中的临床应用.doc

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1、椎芳神经阻滞在开胸手术中的临床应用【摘耍】目的寻求更好的用于开胸手术的麻醉方法。方法选择50例ASAI〜II级择期行开胸手术的病人，随机双盲对照法分为全麻复合椎旁神经阻滞(P)组(n=23)和全身麻醉(G)组(n二27)。测定血中皮质醇(Cor)和血管紧张素II(Angll)的含量；术中监测血压、心率；记录异丙酚、芬太尼的用量(不包括诱导量)，异内酚持续泵入的时间及手术开始至结束的时间；记录患者在麻醉恢复室的恢复时间和烦躁的发牛情况；采用视觉模拟评分(VAS)(患者静止状态和咳嗽时)记录术后伤口

2、疼痛程度。结果①在切皮后30min和术后1d时P组血中的Cor含量显著低于G组(P<0.01)；P组血中的AngII含量在切皮后各时间点均显著低于G组(PV0.01)。②P组血流动力学平稳，在切皮后各时间点的血压显著低于G组(P<0.01)。③P组术中丙泊酚和芬太尼用量、术毕带管回PACU的病人数和烦躁的发生率明显低于G组，恢复时间较G组显著缩短(P<0.05或PV0.01)。④静止状态和咳嗽时的VAS评分P组均显著低于G组(P<0.05,P<0.01)o结论全身麻醉复合椎旁阻滞用于开胸手术是可

3、取的麻醉方法。【关键词】椎旁神经阻滞全身麻醉胸科手术[Abstract】ObjectiveToinvestigatetheeffectofthoracicparavertebralblockcombinedwithgeneralanesthesisforthoracotomy.MethodsFiftypatients(ASAIII),scheduledforselectedthoracicsurgicaloperation,weredividedbyrandomizeddoubleblindco

4、ntroltrialintotwogroups:paravertebralblockcombinedwithgeneralanesthesia(P)group(n=23)andgeneralanesthesia(G)group(n二27).TheinformationincludedserumconcentrationofcortisolandangiotensinII,MAP,HR,dosageofpropofolandfentanyl(excludeinductivedosage),time

5、ofoperationandpropofolpumping,timeofrecoveryandoccurreneeofirritabilityofpatientsinPACU,visualanalogseale(VAS)・Results①TheconcentrationofCoringroupPwassignificantlylowerthanthatingroupGat30minafterskinincisionand1dafteroperation(PV0.01),Theconcentrat

6、ionofAngiotensinIIingroupPwassignificantly1owerthanthatingroupGateveryinvestigatedtimeafterskinincision(PVO.01)・②TngroupPthebloodhemodynamicswasstable,thebloodpressurewassignificantlylowerthanthatingroupGattheeveryinvestigatedtimeafterskinincision(P<

7、0.01)・③IngroupPthedosageofpropofolandfentanylandthenumberofpatientswithintubationafteroperationandoccurrenceofirritabilityinPACUweresignificant!y1owerthanthatingroupG,TimeofrecoveryofissignificantlyshorterthanthatofgroupG(P<0.05orP<0.01)•④TheVASbotha

8、trestandatcoughingofgroupPwassignificantly1owerthanthatofgroupG(P<0.05,P<0.01).ConclusionThoracicparavertebralblockcombinedwithgeneralanesthesiaisagoodwayforthoracicoperation.general【Keywords]paravertebralblockanaesthesia,thoracotomy开胸手术疼痛刺激大，应激反应重，常