【摘要】 目的探讨肝癌射频消融术采用胸椎旁神经阻滞（thoracic paravertebral block,TPVB）麻醉的安全性和有效性。方法选择2013年7月²014年8月于杭州市中医院行肝脏肿瘤射频消融术患者60例,采用随机数字表法分为靶控输注组（G组）和靶控输注复合椎旁阻滞组（GP组）,每组各30例。G组与GP组均采用异丙酚靶控输注至患者OAA/S评分达3分,GP组患者联合TPVB麻醉,术中根据患者疼痛情况给予瑞芬太尼靶控输注。记录手术前（T0）、射频消融开始后5 min（T1）、射频消融开始后10 min（T2）及手术结束时（T3）各时间点的血氧饱和度（oxygen saturation,SpO₂）、脑电双频指数（bispectral index,BIS）值、OAA/S评分及患者合作评分;记录G组和GP组术中所用异丙酚及瑞芬太尼总量。结果术中各时点G组与GP组SpO₂、BIS值、OAA/S评分及患者合作评分比较,GP组均高于G组,差异有统计学意义（P<0.05）;GP组术中异丙酚及瑞芬太尼用量均少于G组,差异有统计学意义（P<0.05）。结论 TPVB应用于肝脏射频消融术,能减少患者术中阿片类药物的应用,患者合作性好,不良反应少。更多还原

【Abstract】 Objective To study the safety and effectiveness of thoracic paravertebral block（TPVB） anesthesia for radiofrequency ablation of liver cancer. Methods A total of 60 patients who were given liver tumor radiofrequency ablation in Hangzhou Hospital of TCM from July 2013 to August 2014 were selected. They were assigned to the target-controlled infusion group（group G） and target-controlled infusion combined with paravertebral block group（group GP）, with30 patients in each group. Propofol target-controlled infusion was applied in both group G and group GP, and OAA/S score was up to 3. group GP was further given TPVB anesthesia. Intraoperative target-controlled infusion of remifentanil was given according to the patient’s pain. The blood oxygen saturation（SpO₂）, bispectral index（BIS）, OAA/S score and patient compliance score were recorded before operation（T0）, 5 min after radiofrequency ablation（T1）, 10 min after radiofrequency ablation and at the end of operation（T3）; the total amount of propofol and remifentanil used in group G and group GP was recorded. Results SpO₂, BIS, OAA/S score and patient compliance score at each time point were compared between group G and group GP, and those in group GP were all higher than those in group G. The differences were significant（P<0.05）; in group GP, the dosage of propofol and remifentanil was less than that in group G, and the difference was significant（P<0.05）. Conclusion TPVB can be used in the treatment of hepatic radiofrequency ablation,which can reduce the application of opioids during surgery, with favorable patient compliance and few adverse reactions.更多还原