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竖脊肌平面阻滞对胸腔镜下肺叶切除术患者超声四肢动脉血流动力学及生化应激指标的影响

Effect of erector spinae plane block on ultrasound-based hemodynamic parameters of arteries of four limbs and biochemical stress indicators in patients with thoracoscopic lobectomy

    摘要
  • 摘要:
    目的 探讨竖脊肌平面阻滞对胸腔镜下肺叶切除术患者超声四肢动脉血流动力学及生化应激指标的影响。
    方法 将120例行胸腔镜下肺叶切除术治疗的患者随机分为研究组和对照组, 每组60例。研究组术中采用竖脊肌平面阻滞, 对照组采用常规麻醉措施。比较2组不同时点麻醉诱导前(T0)、术后拔管后(T1)、术后拔出引流管(T2)的肺功能指标呼气峰流速(PEFR)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、超声四肢动脉血流动力学指标(收缩期最大流速、舒张期最低流速、平均流速、动脉搏动指数以及动脉阻力指数)、应激指标皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)以及促肾上腺皮质激素(ACTH)、镇痛效果。
    结果 2组T1、T2时FEV1、FVC、PEFR均低于T0时, 且研究组T1、T2时FEV1、FVC、PEFR均高于对照组, 差异有统计学意义(P < 0.05)。2组T1、T2时收缩期最大流速、动脉阻力指数均低于T0时, 舒张期最低流速、平均流速、动脉搏动指数均高于T0时, 差异有统计学意义(P < 0.05);研究组T1、T2时收缩期最大流速、动脉阻力指数均高于对照组, 但舒张期最低流速、平均流速、动脉搏动指数均低于对照组, 差异有统计学意义(P < 0.05)。2组T2时Cor、ACTH、AngⅡ、NE高于T0时, 且研究组T2时Cor、ACTH、AngⅡ、NE均低于对照组, 差异有统计学意义(P < 0.05)。研究组Prince-Henry疼痛评分、有效按压次数、实际按压次数低于对照组, 差异有统计学意义(P < 0.05)。
    结论 胸腔镜下肺叶切除术中应用竖脊肌平面阻滞的四肢动脉血流动力学及生化应激指标波动较小, 麻醉效果较好。

     

    Abstract:
    Objective To investigate the effect of erector spinae plane block on ultrasound-based hemodynamic parameters of the arteries of the four limbs and biochemical stress indicators in patients with thoracoscopic lobectomy.
    Methods A total of 120 patients with thoracoscopic lobectomy were randomly divided into study group and control group, with 60 cases in each group.The study group received erector spinae plane block during surgery, while the control group received conventional anesthesia measures.Pulmonary function indicatorspeak expiratory flow rate (PEFR), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), ultrasound-based hemodynamic parameters of the arteries of the four limbs (maximum systolic velocity, minimum diastolic velocity, mean velocity, arterial pulsatility index, and arterial resistance index), stress indicatorscortisol (Cor), norepinephrine (NE), angiotensin Ⅱ(Ang Ⅱ), and adrenocorticotropic hormone (ACTH), and analgesic effect were compared between the two groups at different time pointsbefore anesthesia induction (T0), after extubation (T1), and after drainage tube removal (T2).
    Results FEV1, FVC and PEFR in both groups were significantly lower at T1 and T2 than at T0, and FEV1, FVC and PEFR in the study group were significantly higher than those in the control group at T1 and T2(P < 0.05).The maximum systolic velocity and arterial resistance index in both groups were significantly lower at T1 and T2 than at T0, while the minimum diastolic velocity, mean velocity and arterial pulsatility index were significantly higher at T1 and T2 than at T0(P < 0.05).The maximum systolic velocity and arterial resistance index in the study group were significantly higher than those in the control group at T1 and T2, but the minimum diastolic velocity, mean velocity and arterial pulsatility index were significantly lower than those in the control group (P < 0.05).Cor, ACTH, Ang Ⅱ and NE in both groups were significantly higher at T2 than at T0, and Cor, ACTH, Ang Ⅱ and NE in the study group were significantly lower than those in the control group at T2(P < 0.05).The Prince-Henry pain score, effective compression times, and actual compression times in the study group were significantly lower than those in the control group (P < 0.05).
    Conclusion Application of erector spinae plane block in thoracoscopic lobectomy causes smaller fluctuations in hemodynamic parameters of the arteries of four limbs and biochemical stress indicators, with a better anesthetic effect.

     

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