全身麻醉复合椎旁阻滞对肺叶切除术患者术后恢复的影响

摘要

Objective To evaluate Effects of general anesthesia combined with thoracic paraver-tebral block(TPVB)on postoperative recovery after thoracoscopic pulmonary lobectomy. Methods Eighty patients were randomized into the general anesthesia group( G group)and general anesthesia combined TPVB group(GT group). Under the guidance of ultrasound,patients in the GT group received 20ml of 0. 5% ropivacaine for TPVB,and sevoflurane and propofol for combined anesthesia. Patients in the G group received sevoflurane,propofol and remifentanil for combined anesthesia. Extubation time,postoperative vis-ual analogue scale(VAS),quality of recovery(QoR)score,and adverse reaction were all recorded. Results Patients in the GT group had less extubation time and earlier ambulation time compared to the G group. Postoperatively,at the 1st,24th and 48th hour,patients in the G group had significantly higher VAS values both at rest and on movement than GT group(P < 0. 05). The opioid consumptions in GT group were lower than the G group(P < 0. 05). The QoR values of GT group at 24th and 48th hour[(152 ± 21)min and (175 ± 17)min]were significantly higher than the G group[(134 ± 25)min and(162 ± 20)min]respec-tively. There were significant differences in hospitalization expenses,the hospitalization stay and the inci-dence of complications between the two groups. Conclusion The ultrasound-guided paravertebral block can improve the quality of recovery in patients undergoing thoracoscopic pulmonary lobectomy.%目的：评价全身麻醉复合椎旁阻滞对胸腔镜下肺叶切除术患者术后恢复的影响。方法接受单孔胸腔镜下行肺叶切除术患者80例，随机分为两组，全身麻醉复合超声引导下椎旁神经阻滞组（GT 组）和全身麻醉组（G 组），每组各40例。GT 组患者在超声引导下实施胸椎旁神经阻滞，给予0.5%罗哌卡因20 ml，采用七氟烷、丙泊酚复合麻醉。G 组患者采用七氟烷、丙泊酚、瑞芬太尼复合麻醉。评价术后拔管时间、静止和运动视觉模拟评分（VAS）、术后恢复质量及不良反应。结果 GT 组患者镇痛效果好，术中不需要泵注瑞芬太尼镇痛；GT 组术后拔管时间、苏醒室停留时间短、下床活动时间和进食时间明显短于 G 组（P <0.05），术后1、24、48小时静止和运动VAS 评分低于 G 组（P <0.05），术后24和48小时 QoR-40评分分别为（152±21）分和（175±17）分，G 组分别为（134±25）分和（162±20）分，两组比较差异有统计学意义（P <0.05）；GT 组患者术后恶心和呕吐的发生率分别为7.5%和5%，G 组分别为25%和20%，两组比较差异有统计学意义（P <0.05）；GT 组与 G 组比较，住院时间更短，住院费用更低。结论全身麻醉复合超声引导下胸椎旁阻滞，有利于腔镜肺叶切除术后患者的早期恢复。