CAJ | 학술논문

目的：探讨双侧胸椎旁神经阻滞与术后镇痛对非体外循环冠状动脉搭桥术患者应激反应的影响。方法择期非体外循环冠状动脉搭桥术患者50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25例。P组患者麻醉诱导前经T3～T4间隙行双侧胸椎旁间隙穿刺置管，术后镇痛经两侧硬膜外导管分别持续泵入0.375%罗哌卡因5 ml/h。G组患者用吗啡静脉自控镇痛。记录镇痛开始后12、24、36和48 h疼痛VAS评分及镇静程度评分；观察术后并发症及不良反应；于麻醉前、术毕、术后24及48 h抽取静脉血，测定血浆胰岛素、皮质醇及血管紧张素Ⅱ（ATⅡ）浓度。结果 P组患者镇痛后各时间点时安静痛、咳嗽痛VAS评分及镇静程度Ramsay评分均显著低于G组（P＜0.05）。与麻醉前比较，两组患者胰岛素、皮质醇及ATⅡ水平术毕均升高（P＜0.05），P组患者术后24～48 h降至正常水平。与G组比较，术毕、术后24及48 h胰岛素、皮质醇及ATⅡ水平均低于G组（P＜0.05）。结论双侧胸椎旁神经阻滞与术后镇痛可一定程度上抑制非体外循环冠状动脉搭桥术患者应激激素释放。
목적：탐토쌍측흉추방신경조체여술후진통대비체외순배관상동맥탑교술환자응격반응적영향。방법택기비체외순배관상동맥탑교술환자50례，수궤분위량조：쌍측흉추방신경조체복합전마조（P조）화단순전마조（G조），매조25례。P조환자마취유도전경T3～T4간극행쌍측흉추방간극천자치관，술후진통경량측경막외도관분별지속빙입0.375%라고잡인5 ml/h。G조환자용마배정맥자공진통。기록진통개시후12、24、36화48 h동통VAS평분급진정정도평분；관찰술후병발증급불량반응；우마취전、술필、술후24급48 h추취정맥혈，측정혈장이도소、피질순급혈관긴장소Ⅱ（ATⅡ）농도。결과 P조환자진통후각시간점시안정통、해수통VAS평분급진정정도Ramsay평분균현저저우G조（P＜0.05）。여마취전비교，량조환자이도소、피질순급ATⅡ수평술필균승고（P＜0.05），P조환자술후24～48 h강지정상수평。여G조비교，술필、술후24급48 h이도소、피질순급ATⅡ수평균저우G조（P＜0.05）。결론쌍측흉추방신경조체여술후진통가일정정도상억제비체외순배관상동맥탑교술환자응격격소석방。
ObjectiveTo investigate the effect of bilateral thoracic paravertebral block and postoperative analgesia on stress response in patients undergoing off-pump coronary artery bypass grafting. MethodsFifty patients scheduled for off-pump coronary artery bypass grafting, were randomly divided into two groups(n=25 each): bilateral thoracic paravertebral block combined with general anesthesia group (group P) and pure general anesthesia group(group G). Bilateral thoracic paravertebral block and insertion epidural catheter were performed at T3-4interspace and an infusion of 0.375% ropivacacine was injected at the rate of 5 ml/h up to 48h at the end of the operation in group P. The patients in group G received PCIA with morphine. VAS scores of rest pain, cough pain and sedation score were recorded at 12, 24, 36 and 48 hours after postoperative analgesia beginning. Complications and side effects after operation were recorded. Blood samples were taken to determine the serum insulin, cortisol and angiotensinⅡ concentrations before anesthesia, at the end of operation, postoperative 24 and 48 h respectively. ResultsVAS scores of rest pain, cough pain and sedation score in group P were significantly lower than in group G at the four points(P<0.05). The levels of insulin, cortisol and angiotensinⅡat the end of operation were higher than before anesthesia(P<0.05) and declined to normal levels at postoperative 24 or 48 h in group P. Compared with group G, the levels of insulin, cortisol and angiotensinⅡ were significantly lower in group P at the end of operation, postoperative 24 and 48 h respectively(P<0.05). ConclusionBilateral thoracic paravertebral block and postoperative analgesia could decrease the level of stress hormone in patients undergoing off-pump coronary artery bypass grafting.