Application effect of general anesthesia combined with ultrasound-guided paravertebral nerve block on rapid recovery of thoracic-laparoscopic radical esophagectomy
LIN Xu-lin ZHANG Long-sheng ZHANG Huan-kai
Department of Anesthesiology, Jieyang People′s Hospital, Guangdong Province, Jieyang 522000, China
摘要目的 探讨全身麻醉结合超声引导下椎旁神经阻滞（USG-PVB）在快速康复胸-腹腔镜食管癌根治术（TLE）中的应用效果。方法 选取2018年3～9月在我院行TLE 的50 例患者作为研究对象，随机分为观察组和对照组，每组各25 例。观察组在全身麻醉诱导下行USG-PVB，对照组只行全身麻醉诱导。观察并记录患者术中血管活性药物以及麻醉药品用量，两组患者术前及术后2、4、7 d 利用简易智力状态量表（MMSE）进行认知功能评价。记录患者术后1、12、24 h 的疼痛视觉模拟评分（VAS 评分）。结果 观察组术中舒芬太尼、瑞芬太尼以及丙泊酚用量明显低于对照组，去氧肾上腺素的用量高于对照组（P＜0.05）；两组患者术前及术后7 d 的MMSE 评分比较，差异无统计学意义（P＞0.05）；观察组术后2、4 d 的MMSE 评分明显高于对照组（P＜0.05）；观察组术后1、12、24 h 的VAS评分均明显低于对照组（P＜0.05）。结论 全身麻醉联合USG-PVB 能够减少患者术中麻醉以及血管活性药品的用量，改善患者的早期认知功能障碍，能够较快提高患者的生活质量，值得临床推广应用。
Abstract：Objective To investigate the application effect of general anesthesia combined with ultrasound-guided paravertebral nerve block (USG-PVB) on rapid recovery of thoracic-laparoscopic radical esophagectomy (TLE). Methods Fifty patients who underwent TLE in our hospital from March to September 2018 were selected as the subjects, and randomly divided into observation group and control group, with 25 cases in each group. The USG-PVB was applied to the observation group under the induction of general anesthesia,and the control group only carrier out the induction of general anesthesia. The amount of vasoactive drugs and narcotic drugs in patients during surgery was observed and recorded. Cognitive function evaluation was performed using the simple intelligence state scale (MMSE) before and 2, 4,and 7 days after surgery. The pain visual analogue scale (VAS) score was observed at 1, 12, and 24 hours after surgery.Results The doses of sufentanil, remifentanil and propofol in the observation group were lower than those in the control group, the amount of phenylephrine was significantly higher than that of the control group (P＜0.05). There were no significant differences in MMSE scores between the two groups before and 7 days after surgery (P＞0.05). The MMSE scores of the observation group at 2 and 4 d after operation were significantly higher than those of the control group (P＜0.05). The VAS score of the observation group at 1, 12, 24 h after operation were significantly lower than thoes of the control group (P＜0.05). Conclusion General anesthesia combined with USG-PVB nerve block can reduce the amount of intraoperative anesthesia and vasoactive drugs, improve early cognitive dysfunction, and improve the quality of life of patients quickly. It is worthy of clinical application.
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