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|本期目录/Table of Contents|

双侧胸椎旁神经阻滞复合全麻对心内直视手术患者应激反应的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第1期
页码:
85-087
栏目:
临床研究
出版日期:
2014-09-25

文章信息/Info

Title:
Effect of bilateral thoracic paravertebral block combined with general anesthesia on stress response in patients undergoing open heart surgery
作者:
孙立新1; 张明泳2; 潘巍巍3; 王明山1; 王 强1
(青岛市市立医院：1.麻醉科，2.呼吸科，3.干部保健科，山东 青岛 266071)
Author(s):
SUN Li-xin1;  ZHANG Ming-yong2;  PAN Wei-wei3;  WANG Ming-shan1;  WANG Qiang1
(1.Department of Anesthesiology, 2.Department of Respiratory Medicine, 3.Department of Health Care, Qingdao Municipal Hospital, Qingdao 266071, Shandong, China)
关键词:
神经传导阻滞; 胸椎; 心内直视手术; 应激反应
Keywords:
nerve block;  thoracic vertebra;  open heart surgery;  stress response
分类号:
R564.2
DOI:
-
文献标识码:
A
摘要:
目的:探讨双侧胸椎旁神经阻滞复合全麻对心内直视手术患者应激反应影响。方法： 择期二尖瓣置换术患者40例，随机分为两组：双侧胸椎旁神经阻滞复合全麻组（P组）和单纯全麻组（G组），每组20例。P组患者麻醉诱导前经T3、4间隙行双侧胸椎旁间隙穿刺置管，两侧分别注射试验剂量3.75 g/L罗哌卡因5 ml，5 min后分别给予首次量3.75 g/L罗哌卡因15 ml。于麻醉前、体外循环(CPB)前、术毕及术后24 h抽取静脉血，测定血浆胰岛素、皮质醇及血管紧张素Ⅱ（AngⅡ）浓度。记录两组心脏复跳情况、术后正性肌力药使用率、机械通气时间、ICU滞留时间、肺部并发症发生率、心衰发生率及死亡率。结果： 与麻醉前比较，两组患者胰岛素、皮质醇及AngⅡ水平均从CPB前开始升高，至术毕达到高峰(P<0.05或P<0.01)，P组患者术后24 h降至正常水平。与G组比较，胰岛素水平在术后24 h两组差异无统计学意义，术毕及术后24 h皮质醇及AngⅡ水平均低于G组(P<0.05)，术毕胰岛素水平低于G组（P<0.05）。P组患者术后24 h多巴胺使用量、机械通气时间明显低于G组(P<0.05)。结论： 双侧胸椎旁神经阻滞可一定程度上抑制心内直视手术患者应激激素释放。
Abstract:
AIM:To explore the effect of bilateral thoracic paravertebral block combined with general anesthesia on stress response in patients undergoing open heart surgery. METHODS: Forty patients scheduled for mitral valve replacement were randomly divided into two groups (n=20 each): bilateral thoracic paravertebral block combined with general anesthesia group (group P) and only general anesthesia group (group G). Bilateral thoracic paravertebral block and epidural insertion catheter were performed at T3,T4 interspace prior to induction of anesthesia in group P. A test dose (5 ml of 3.75 g/L ropivacacine) was injected through the catheter on two sides. After 5 min, a bolus dose of 15 ml of 3.75 g/L ropivacacine was injected. Blood samples were taken to determine serum insulin, cortisol and angiotensin II concentrations, respectively, before anesthesia, before cardiopulmonary bypass (CPB), at the end of operation and 24 h postoporatively. Clinical data including parameters of heart resuscitation, dosages of positive inotropic agent, time of mechanical ventilation, ICU stay, pulmonary complications, heart failure and death were recorded in both groups. RESULTS: Compared with those before anesthesia, levels of insulin, cortisol and angiotensin II began to rise from before CPB, peaked at the end of operation (P<0.05 and P<0.01) and declined to normal levels 24 h postoperatively in group P. No significant difference was observed in the level of insulin between groups at 24 h postoperatively. Levels of insulin, cortisol and angiotensin II in group P were significantly lower than those in group G (P<0.05) at the other time points after operation. Dosages of positive inotropic agent and time of mechanical ventilation in group P were significantly lower than those in group G (P<0.05). CONCLUSION: Bilateral thoracic paravertebral block decreases the level of stress hormone in patients undergoing open heart surgery.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2014-04-07.
基金项目：青岛市科技发展指导计划项目资助（KJZD-13-14-NSH）
通讯作者：潘巍巍，主治医师，主要从事心脏病的临床与基础研究Email：1392150333@qq.com
作者简介：孙立新，副主任医师，硕士Email：sunlixin1221@sina.com
更新日期/Last Update: 2015-01-20