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目的研究椎旁阻滞辅助全身麻醉对食管癌手术患者循环及术后镇痛的影响。方法选择2014年6月至2016年12月行食管癌根治术患者80例,ASA分级Ⅰ级或Ⅱ级,依入院先后顺序分为两组:椎旁阻滞辅助全身麻醉组(n=40,Ⅰ_组),硬膜外阻滞辅助全身麻醉组(n=40,Ⅱ组)。观察两组患者入室静息状态(T0)、阻滞后5 min(T1)、全身麻醉诱导气管插管后(T2)、单肺通气后30 min(T_3)、体位变成侧卧位后(T_4)和手术结束气管内拔管前(T_5)的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP);于术毕缝皮时连接患者自控静脉镇痛泵(PCIA),记录术后不同时间点的疼痛视觉模拟评分(VAS)、术后PCIA总按压次数及不良反应的出现情况。结果组内对比,与T0时点比较,两组MAP值在T1~T_4时均显著降低(P<0.05),CVP值在T_5时点差异有统计学意义(P<0.05);组间对比,在T2、T_3时间点,MAP值差异有统计学意义(P=0.000,P=0.036);在T_3点,CVP值差异有统计学意义(P=0.026);在T_4、T_5时点,HR值有明显波动(P=0.042,P=0.005)。在术后1~6 h阶段,组间比较差异有统计学意义(P=0.004)。结论对于食管癌手术患者,选择椎旁阻滞辅助全身麻醉可以在围术期保持良好的循环稳定,同时术后又可达到有效镇痛。
Objective To study the effects of paravertebral block assisted general anesthesia on circulatory and postoperative analgesia in esophageal cancer patients. Methods From June 2014 to December 2016, 80 patients undergoing esophageal cancer radical mastectomy were divided into two groups according to the order of hospital admission: paravertebral block assisted general anesthesia group (n = 40, Ⅰ_ group), epidural block assisted general anesthesia group (n = 40, Ⅱ group). The patients in the two groups were observed for resting status (T0), 5 min after block (T1), after general anesthesia-induced endotracheal intubation (T2) and 30 min after single lung ventilation (T_3) (HR), mean arterial pressure (MAP) and central venous pressure (CVP) at the end of endotracheal intubation (T_4) and at the end of surgery (T_5) The pain visual analogue scale (VAS), the total number of postoperative PCIA pressing and the occurrence of adverse reactions were recorded at different time points after operation. Results Compared with T0, the MAP of both groups were significantly decreased at T1 ~ T4 (P <0.05), and the difference of CVP at T5 was statistically significant (P <0.05) There were significant differences in MAP values between T2 and T_3 (P = 0.000, P = 0.036). At T_3, there were significant differences in CVP between two groups (P = 0.026). At T_4 and T_5, There was a significant fluctuation (P = 0.042, P = 0.005). The difference between the two groups was statistically significant (P = 0.004) at 1 to 6 h after surgery. Conclusion For patients with esophageal cancer surgery, the choice of paravertebral block assisted general anesthesia in the perioperative period to maintain a good cycle of stability, while postoperative effective analgesia can be achieved.