超声引导下椎旁阻滞对不同民族食管癌根治术患者术后恢复的影响-现代医学

超声引导下椎旁阻滞对不同民族食管癌根治术患者术后恢复的影响

单位：1. 新疆医科大学研究生学院, 新疆乌鲁木齐 830054;
2. 新疆维吾尔自治区人民医院麻醉科, 新疆乌鲁木齐 830000

分类号：R735.1

出版年·卷·期（页码）：2018·46·第五期（497-502）

摘要：

目的：评价全身麻醉复合超声引导下胸椎椎旁神经阻滞对不同民族患者胸腹腔镜食管癌根治术术后恢复的影响。方法：随机选取2016年4月至12月在新疆维吾尔自治区人民医院接受胸腹腔镜食管癌根治术的80例患者，依照民族及麻醉方式分组，分为全麻汉族组（HJ组）、全麻哈萨克族组（KJ组）、全麻复合椎旁阻滞汉族组（HZ组）和全麻复合椎旁阻滞哈萨克族组（KZ组），每组各20例。4组患者均以相同麻醉药物进行诱导，术中均采用静-吸复合麻醉，HZ、KZ组于手术结束时给予30 ml 0.4%罗哌卡因行第七胸椎（T7）单次胸椎旁阻滞，HJ、KJ组于手术结束时给予舒芬太尼静脉自控镇痛。术后采用视觉疼痛模拟评分（VAS）评估4组患者术后1、4、8、12、24 h静止及活动疼痛情况，记录并比较4组术后恢复的各监测指标情况。结果：术后4、8、12 h，HZ、KZ组的VAS分别低于HJ、KJ组（P<0.05）。术后8、12 h，HJ组较KJ组的VAS低（P<0.05），KZ组与HZ组差异无统计学意义（P>0.05）。4组监护室停留时间、下床活动时间、进食时间、住院时间和住院费用比较，KZ组最优（P<0.05）；KJ组恶心呕吐发生率最高（P<0.05），HZ组与KZ组差异无统计学意义（P>0.05）。结论：食管癌根治术术后超声引导下胸椎旁阻滞镇痛较静脉镇痛效果好；不同民族患者术后镇痛效果一致，全麻复合椎旁阻滞下哈萨克族患者术后恢复迅速。

Objective: To evaluate the postoperative recovery effect of thoracic laparoscopic esophageal carcinoma radical mastectomy of different nationalities' patients by thoracic paravertebral nerve block under combined ultrasound guidance for general anesthesia.Methods: 80 cases of laparoscopic radical esophagectomy for esophagus cancer in Xinjiang Uygur Autonomous Region People's Hospital from from April to December 2016, were divided into general anesthesia Han group (HJ) and the general anesthesia Kazak group (KJ), General anesthesia combined with paravertebral block Han group (HZ) and General anesthesia combined with paravertebral block Kazak group (KZ), 20 cases in each group. The four groups were induced by the same narcotic drugs, static inhalation combined anesthesia were used, Group HZ and KZ were given 30 ml 0.4% ropivacaine at the end of the operation on the end of the seventh thoracic vertebra (T7) paravertebral block. Group HJ and KJ were given sufentanil for intravenous analgesia at the end of the operation. The visual pain simulation score (VAS) was used to evaluate the 1, 4, 8, 12, 24 h and active pain in four groups of patients after operation. The monitoring indexes of four groups after operation were recorded and compared.Results: VAS at 4 h, 8 h and 12 h in HJ group and KJ group were lower than those in HZ group and KZ group (P<0.05). VAS in KJ group were lower than those in HJ group at 8 h and 12 h (P<0.05). There was no statistical difference between group KZ and group HZ (P>0.05). The residence time in monitoring room, the time to go out of bed, eating time, hospitalization days and cost of hospitalization in the four groups were compared, group KZ was the best(P<0.05). The incidence of nausea and vomiting in KJ group was the highest (P<0.05), There was no statistical difference between group HZ and group KZ(P>0.05).Conclusion: Paravertebral block analgesia guidedunder ultrasound after radical resection of esophageal carcinoma is better than intravenous analgesia, the postoperative analgesic effects of different ethnic groups are consistent, the recovery of Kazakh patients under general anesthesia combined with paravertebral block is fast after operation.

参考文献：

[1] 曹彬,何晓峰.食管癌患者围术期不同营养支持方式的临床观察研究[J].东南大学学报(医学版),2017,36(4):571-573.
[2] 王一帆,金健,李蔼健,等.胸腔镜下食管癌根治手术的初期经验[J].现代医学,2015,43(3):278-281.
[3] 马师琦,高峰.20年前后新疆哈萨克族食管癌发病状况对比[J].中国医药科学2013,3(7):80-82.
[4] 中华医学会麻醉学分会.2014版中国麻醉学指南与专家共识[M].北京:人民卫生出版社,2014:181-186.
[5] SCHNABEL A, REICHL S U, KRANKE P, et al. Efficacy and safety of paravertebral blocks in breast surgery:a meta-analysis of randomized controller trials[J].Br J Anaesth,2010,105(6):842-852.
[6] DANGO S, HARRIS S, OFFNER K, et al. Combined paravertebral and intrathecal vs thoracic epidural analgesia for post-thoracotomy pain relief[J].Br J Anaesth, 2013,110(3):443-449.
[7] DAVIES R G, MYLES P S, GRAHAM J M. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy-a systemativ review and meta-analysis of randomized trials[J].Br J Anaesth, 2006, 96(4):418-426.
[8] 王琪, 吴明, 沈钢, 等. 快速康复外科在微创食管癌切除术中的应用[J].中华胸心血管外科杂志,2013, 29(6):349-353.
[9] 田杨, 许挺, 徐懋. 超声引导下胸椎旁阻滞的进展[J].中国微创外科杂志,2016,16(4):359-361.
[10] YOSHIDA T, FUJIWARA T, FURUTANI K, et al. Effects of ropivacaine concentration on the spread of sensory block produced by continuous thoracic paravertebral block:a prospective, randomised, controlled, double-blind study[J].Anaesthesia 2014, 69:231-239.
[11] 汲振荣, 唐冰, 裴凌. 超声引导下椎旁神经阻滞在开胸手术及术后镇痛中的应用[J].中国医师进修杂志, 2016, 39(2):168-171.
[12] VOGT A, STIEGER D S, THEURILLAT C, et al. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery[J].Br J Anaesth, 2005,95(6):816-821.
[13] 柯雪茹, 雷波, 王明春, 等. 新疆维吾尔族与哈萨克族和汉族患者疼痛敏感性及舒芬太尼镇痛剂量的比较研究[J].中国全科医,2016,19(8):916-919.
[14] 罗铁山, 赵涛, 张磊磊, 等. 新疆汉、哈族胃癌根治术患者术后舒芬太尼镇痛效果的比较[J].中国疼痛医学杂志,2014,20(4):241-243.
[15] 张莉, 李擎, 张建清, 等. 新疆汉族与少数民族晚期食管癌患者放疗前后生活质量比较[J].中华放射肿瘤学杂志, 2011, 20(4):295-296.
[16] 辜晓岚, 何建华, 顾连兵, 等. 超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].临床麻醉学, 2015,1(31):18-21.
[17] WANG L, McLEOD H L, WEINSHILBOUM R M. Genomics and drug response[J].N Engl J Med, 2011, 364:1144-1153.
[18] 朱雁铃, 彭捷, 吴友平, 等. 全麻复合胸椎旁阻滞对弹孔胸腔镜手术术后疼痛及快速康复的影响[J].临床麻醉学杂志, 2015, 12(31):1153-1156.
[19] 邱敏,付勤. 脊柱后路手术多模式镇痛疗效分析[J].东南大学学报(医学版),2016, 35(3):398-401.
[20] 廖明锋, 迟晓慧, 罗爱林, 等. 全身麻醉复合椎旁阻滞对肺叶切除术患者术后恢复情况的影响[J].临床外科杂志,2016,24(9):709-711.
[21] 章蔚, 李娟, 耿擎天, 等. 单点或多点胸椎旁神经阻滞在胸腔镜肺叶切除患者术后镇痛的临床研究[J].临床麻醉学杂志, 2014, 30(2):109-113.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录