全凭静脉麻醉联合持续竖脊肌平面阻滞在非插管胸腔镜手术中的应用研究

张海亮; 郝静静; 路喻清; 白延斌; 张军

doi:10.7619/jcmp.202003019

全凭静脉麻醉联合持续竖脊肌平面阻滞在非插管胸腔镜手术中的应用研究

1. 延安大学附属医院麻醉科, 陕西延安, 716000;
2. 延安大学附属医院儿科, 陕西延安, 716000;
3. 咸阳彩虹医院麻醉科, 陕西咸阳, 712000

基金项目:

陕西省自然科学基础研究计划(2018JM7067)

详细信息

通讯作者:
张军,E-mail:825663432@qq.com

中图分类号: R614
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出版历程
- 收稿日期: 2019-11-09

Application of total intravenous anesthesia combined with continuous erector spinae plane block in non-intubation thoracoscopic surgery

1. Department of Anesthesiology, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, 716000;
2. Department of Pediatrics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, 716000;
3. Department of Anesthesiology, Xianyang Rainbow Hospital, Xianyang, Shaanxi, 712000

摘要

摘要: 目的观察全凭静脉麻醉联合持续竖脊肌平面(ESP)阻滞在保留自主呼吸非插管胸腔镜患者手术中应用的有效性和安全性。方法选择60例择期行胸腔镜手术患者作为研究对象,将其随机分为全凭静脉麻醉组(T组)和全凭静脉麻醉联合持续ESP阻滞保留自主呼吸组(ESP组)。记录2组患者一般情况,并分别于麻醉诱导前(T₀)、手术开始后10 min(T₁)、手术开始后30 min(T₂)、拔管前(T₃)、术后12 h(T₄)检测2组患者血中去甲肾上腺素、肾上腺素和皮质醇水平,比较T₀、T₁、T₂、T₃时点2组患者的血流动力学指标结果［平均动脉压(MAP)和心率(HR)］, 比较2组患者术后不同时点静息和运动的视觉模拟评分法(VAS)评分,记录2组患者苏醒时间、住院时间和术后咽喉痛、恶心、呕吐等不良事件发生率。结果 T₁、T₂、T₃、T₄时, 2组患者的去甲肾上腺素、肾上腺素和皮质醇水平均高于T₀时,而ESP组的去甲肾上腺素、肾上腺素和皮质醇水平均低于T组,差异有统计学意义(P < 0.05); ESP组患者术后苏醒时间、住院时间短于T组,术后24 h内静息VAS评分、48 h内运动VAS评分低于T组,差异均有统计学意义(P < 0.05); ESP组T₁、T₂、T₃时的MAP、HR均较T组稳定,差异有统计学意义(P < 0.05); ESP组术后咽喉痛、恶心、呕吐发生率低于T组,差异有统计学意义(P < 0.05)。结论全凭静脉麻醉联合持续竖脊肌平面阻滞应用于非插管胸腔镜手术中有一定可行性,术中血流动力学平稳,围术期应激反应小,术后并发症少,有利于患者早期康复。
- 全凭静脉麻醉 /
- 竖脊肌平面阻滞 /
- 自主呼吸 /
- 胸腔镜手术
Abstract: Objective To observe the efficacy and safety of total intravenous anesthesia combined with continuous erector spinae plane block in patients with thoracoscopic surgery with retained breathing and non-intubation. Methods A total of 60 patients undergoing thoracoscopic surgery in our hospital were selected, and were randomly divided into total intravenous anesthesia group(T group), and intravenous anesthesia combined with ESP block and breathing retention group(ESP group). The general situation of the two groups were recorded. Norepinephrine, adrenaline and cortisol levels were measured before anesthesia induction(T₀), after operation(T₁), at 30 min after operation(T₂), before extubation(T₃)and at 12 h after operation(T₄). The hemodynamic indicators such as mean arterial pressure(MAP)and heart rate(HR)at T₀, T₁, T₂, T₃ of two groups were compared. The Visual Analogue Scale(VAS)pain scores at rest and exercise were recorded at different time points after operation, and the recovery time, hospitalization time and the incidence of adverse - events such as postoperative sore throat, nausea, vomiting were recorded. Results Compared with T₀, the levels of norepinephrine, epinephrine and cortisol in both groups were increased at time points of T₁, T₂, T₃, T₄, but were lower in ESP group than those in T group at the same time points. The recovery time and hospitalization time in ESP group were shorter, and resting VAS pain score within 24 hours after operation and exercise VAS score within 48 hours were lower than those in T group(P < 0.05). The MAP, HR at T_1~3 in ESP group was more stable than that in T group(P < 0.05), and the incidence of sore throat, nausea and vomiting was significantly decreased at T_1~3(P < 0.05). Conclusion Intravenous anesthesia combined with continuous erector spinae plane block is feasible in non-intubation thoracoscopic surgery, which has the features of stable hemodynamics, lower perioperative stress response, and less postoperative complications, and is conductive to the early rehabilitation.
- total intravenous anesthesia /
- erector spinae plane block /
- autonomous respiration /
- thoracoscopic surgery

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