【摘要】 目的观察超声引导下肋间神经超前镇痛对胸腔镜手术患者脑钠肽（BNP）和心功能的影响。方法连续纳入2015年11月²016年6月我院心胸外科拟行胸腔镜手术的患者50例,随机分为全麻联合超声引导下肋间神经阻滞组（GN组,n=25）和单纯全麻组（G组,n=25）。抽取患者术前1天、术后第3天、术后第7天的静脉血测量BNP值;术前及术后第7天进行心脏彩超检查,记录左室射血分数（LVEF）、左室舒张末期内径（LVEDD）的具体数值;记录患者手术后2h（Ta）、4h（Tb）、6h（Tc）、8h（Td）、24h（Te）动态及静态的视觉模拟评分（VAS）。分别在进入手术室（T₁）、插入气管导管后（T₂）、切皮后5min（T₃）、单肺通气后5min（T₄）、手术结束时（T5）记录两组患者的平均动脉压和心率。结果两组患者术后第3天、第7天的BNP值均比术前1天高（P<0.05）,且GN组患者在术后第3天、第7天的BNP值比G组患者低（P<0.05）。术后第7天两组的LVEDD值比术前高,且G组比GN组高（P<0.05）;手术后第7天G组的LVEF值比术前和GN组均低（P<0.05）。术后VAS评分在静态、动态的Ta、Tb时GN组明显小于G组（P<0.05）。与T₁时比较,T2时两组的MAP有所降低（P<0.05）;T₃、T₄、T₅时G组的MAP比T₁时、GN组均高（P<0.05）。T₃、T₄、T₅时G组的HR比T1时、GN组均高（P<0.05）。结论超声引导下肋间神经超前镇痛联合全麻,能够使胸腔镜手术对患者BNP及心功能的影响相对减轻,适用于胸腔镜手术及术后疼痛的治疗。更多还原

【Abstract】 Objective To observe the effect of intercostal nerve preemptive analgesia on BNP and cardiac function after video-assisted thoracoscopic surgery. Methods Selected 50 patients who accepted video-assisted thoracoscopic surgery(VATS)from Nov 2015 to Jun 2016 in our hospital. They were randomly divided into two groups, group GN and group G. Recorded venous blovd one day before surgery,three days and seven days after surgery for BNP value,preoperative and postoperative seventh days blood was measured by echocard-iography. The specific numerical documented LVEF, LVEDD, mean arterial pressure and heart rate were recorded when entered operation room(T1)and inserted the endotracheal tube(T2),5min after skin incision, 5min after single lung ventilation(T4),the end of surgery(T5). Results At the third day and seventh day after operation, the value of BNP in both groups were higher than preoperation(P<0.05). The value of BNP in group GN at the third and seventh day after surgery was lower than group G(P<0.05). The LVEDD value of both groups was higher than that preoperation, goup G was higher than group GN(P<0.05). The LVEF value of group G at the seventh day after surgery was lower than preoperation and group GN(P<0.05). The VAS score at the static state and dynamic state of Ta,Tbof group GN was lower than group G. Compared with T1, the MAP at T2 of two groups were decreased(P<0.05), the MAP of group G at T3, T4, T5 was lower than T1 and group GN(P<0.05). The HR of group G at T3,T4,T5 was higher than T1 and group GN. Conclusion Intercostal nerve preemptive analgesia combined with general anesthesia could decrease the effect on BNP and cardiac function. It is suitable for video-assisted thoracoscopic surgery and postoperation pain.更多还原