【摘要】 目的探讨全身麻醉复合超声引导下胸椎旁阻滞（T_PVB）对开胸患者术后疼痛及应激反应的影响。方法选取2015年3月²016年10月在我院行择期食管癌开胸手术的48例患者,随机分为单纯全身麻醉组（对照组）和全身麻醉复合胸椎旁神经阻滞组（观察组）,各24例。两组全身麻醉方法相同,观察组在全身麻醉诱导前行超声引导下胸椎旁神经阻滞,术后均静脉自控镇痛。记录麻醉前（T₁）、气管插管即刻（T₂）、手术开始后30 min（T₃）、术毕（T₄）、术后2 h（T₅）的血流动力学以及T₅、术后4 h（T₆）、术后8 h（T₇）、术后24 h（T₈）、术后48 h（T₉）的VAS评分和Ramsay镇静评分,检测T₁、T₃、T₄、T₈时的去甲肾上腺素（NE）、肾上腺素（E）和多巴胺（DA）,记录术后镇痛泵按压次数、舒芬太尼用量、镇痛满意度以及相关并发症。结果与对照组比较,观察组T₂、T₃、T₄时刻的SBP、DBP、HR均较高（P<0.05）;观察组T₅、T₆、T₇、T₈、T₉安静及活动时的VAS评分较低（P<0.05）,Ramsay镇静评分无差异（P>0.05）;观察组T₃、T₄时刻的NE、E较高（P<0.05）,T₅时刻的NE、E较低（P<0.05）,T₄、T₅时刻的DA较低（P<0.05）;观察组的镇痛泵按压次数较少（P<0.01）,0¹2 h、>12²4 h的舒芬太尼用量较少（P<0.01）,镇痛满意率较高（P<0.05）。结论全身麻醉复合超声引导下胸椎旁神经阻滞能为开胸手术提供有效镇痛,可以更好地抑制应激反应,并减少术后镇痛药物需要量。更多还原

【Abstract】 Objective To investigate the influence of thoracic paravertebral block（TPVB） on postoperative pain and stress response in patients undergoing thoracotomy under general anesthesia combined with ultrasound.Methods From March 2015 to October 2016,48 esophageal cancer patients undergoing thoracotomy in selective period were selected and randomly divided into the simple general anesthesia group（the control group） and the general anesthesia combined with TPVB group（the observation group）,24 cases in each group.The general anesthesia applied in the two groups was the same.In the observation group,the ultrasound-guided TPVB was performed before induction of general anesthesia.The intravenous patient-controlled analgesia after surgery was used.The hemodynamics were recorded before anesthesia（T₁）,immediately after endotracheal intubation（T₂）,30 min after operation（T₃）,just after surgery（T₄）,2 h after surgery（T₅）,and visual analogue scale（VAS） and Ramsay scores at T₅,4 h after operation（T₆）,8 h after operation（T₇）,24 h after operation（T₈）,and 48 h after operation（T₉） were also recored.The levels of norepinephrine（NE）,epinephrine（E）,and dopamine（DA） at T₁,T₃,T₄,T₈ were detected.The number of postoperative analgesia pump press,sufentanil dose,analgesic satisfaction,and relevant complications were also recorded.Results Compared with the control group,systolic blood pressure（SBP）,diastolic blood pressure（DBP）, and heart rate（HR） at T₂,T₃ and T₄ were all higher in the observation group（P<0.05）.The VAS scores at T₅,T₆,T₇,T₈ and T₉ in both quietness and activity were lower in the observation group（P<0.05）.There was no difference in Ramsay sedation score between the two groups（P>0.05）.The levels of NE and E were higher in the observation group at T₃ and T₄（P<0.05） and decreased at T₅（P<0.05）.The levels of DA was lower at T₄ and T₅（P<0.05）.The number of analgesia pump press was less（P<0.01）.The sufentanil dose was less at 0-12 h and >12-24 h（P <0.01）.The analgesic satisfaction was higher（P <0.05）.Conclusion General anesthesia combined with ultrasound-guided TPVB can provide effective analgesia for thoracotomy,greatly inhibit stress response,and reduce the dose of postoperative analgesic drugs.更多还原