全身麻醉联合超声引导下椎旁神经阻滞用于食管癌胸腹腔镜手术中的价值

doi:10.3969/j.issn.1671-7171.2024.10.029

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摘要【目的】探讨全身麻醉(全麻)联合超声引导下椎旁神经阻滞(USG-PVB)用于食管癌胸腹腔镜手术中的价值。【方法】86例食管癌患者,随机分为观察组与对照组,每组43 例。两组均行胸腹腔镜手术,对照组采用全身麻醉,观察组采用全麻联合 USG-PVB 麻醉。比较两组患者术中药物用量及围术期指标;于术后4 h(T₁)、术后24 h(T₂)、术后48 h(T₃)采用Ricker镇静-躁动评分(SAS)评估患者躁动情况,以视觉模拟评分法(VAS)评估患者疼痛情况;比较两组不同时点免疫功能[CD3⁺、CD4⁺、自然杀伤细胞(NK)]水平;比较两组并发症发生情况。【结果】观察组丙泊酚、瑞芬太尼、舒芬太尼术中用量均低于对照组(P<0.05),去氧肾上腺素用量高于对照组(P<0.05),两组麻黄碱、尼卡地平用量比较,差异无统计学意义(P>0.05)。观察组拔管时间、清醒时间、术后住院时间显著短于对照组(P<0.05),两组手术时间比较,差异无统计学意义(P>0.05)。观察组T₁、T₂、T₃时SAS、VAS评分显著低于对照组(P<0.05),CD3⁺、CD4⁺、NK水平显著高于对照组(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。【结论】在食管癌胸腹腔镜术中应用全麻联合USG-PVB麻醉方案,可有效减少术中药物使用量,有利于患者术后恢复,同时能够减轻患者术后躁动及疼痛,对免疫功能影响小,且并发症发生较少,值得临床推广应用。

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关键词 ：食管肿瘤/外科学, 麻醉,全身, 胸腔镜检查, 腹腔镜检查, 神经传导阻滞

Abstract：【Objective】 To investigate the value of general anesthesia combined with ultrasound-guided paravertebral nerve block (USG-PVB) in thoracic laparoscopic surgery for esophageal cancer. 【Methods】 A total of 86 patients who underwent thoracic laparoscopic surgery for esophageal cancer were randomly divided into the observation group and the control group, 43 cases in each group. Both groups underwent thoracic laparoscopic surgery, the control group was given general anesthesia, and the observation group was given general anesthesia combined with USG-PVB anesthesia. Intraoperative drug dosage and perioperative indexes were compared between the two groups. At 4 h(T₁), 24 h(T₂) and 48 h(T₃), restlessness was assessed by Ricker sedation-agitation score (SAS) and pain was assessed by visual analog scale (VAS). The levels of immune function [CD3⁺, CD4⁺, natural killer cells (NK)] were compared between the two groups at different time points. The incidence of complications was compared between the two groups. 【Results】The intraoperative dosage of propofol, remifentanil and sufentanil in the observation group was significantly lower than that in the control group (P<0.05), and the dosage of deoxyadrenaline was significantly higher than that in the control group (P<0.05). There was no statistical significance in the dosage of ephedrine and nicadipine between two groups (P>0.05). The extubation time, waking time and postoperative hospitalization time in the observation group were significantly shorter than those in the control group (P<0.05), and there was no statistical significance in the operation time between the two groups (P>0.05). The SAS and VAS scores of the observation group at T₁, T₂ and T₃ were significantly lower than those of the control group (P<0.05). The levels of CD3⁺, CD4⁺ and NK were significantly higher than those of the control group (P<0.05). There was no significant difference in the total incidence of complications between the two groups (P>0.05). 【Conclusion】The application of general anesthesia combined with USG-PVB anesthesia in thoracic laparoscopic surgery for esophageal cancer can effectively reduce the use of intraoperative drugs, which is conducive to postoperative recovery of patients, and can alleviate postoperative agitation and pain of patients, with little impact on immune function and fewer complications, which is worthy of clinical promotion and application.

Key words： Esophageal Neoplasms/SU Anesthesia, General Thoracoscopy Laparoscopy Nerve Block

收稿日期: 2023-08-16

中图分类号:

R735.1

通讯作者: *E-mail:zhetiantian2023@163.com

引用本文:

折甜甜, 田龙飞, 孙逸飞. 全身麻醉联合超声引导下椎旁神经阻滞用于食管癌胸腹腔镜手术中的价值[J]. 医学临床研究, 2024, 41(10): 1557-1560.
ZHE Tiantian, TIAN Longfei, SUN Yifei. Value of General Anesthesia Combined with Ultrasound-guided Paravertebral Nerve Block in Thoracic Laparoscopic Surgery for Esophageal Cancer. JOURNAL OF CLINICAL RESEARCH, 2024, 41(10): 1557-1560.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2024.10.029 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2024/V41/I10/1557