CAJ | 학술논문

目的：探讨超声引导下连续椎旁神经阻滞（PVNB）复合全身麻醉对胸腔镜肺大泡切除术应激反应的影响。方法择期行胸腔镜下肺大泡切除术患者60例随机均分为三组：A组单纯全身麻醉，术后静脉自控镇痛；B组连续硬膜外阻滞复合全身麻醉，术后连续硬膜外镇痛；C组超声引导下连续PVNB复合全身麻醉，术后连续PVNB镇痛。记录麻醉前（T0）、椎旁或硬膜外给药15 min后（T1）、气管插管后（T2）、切皮后5 min（T3）和术毕（T4）的MAP和 HR。检测术前、术后2、12、24和48 h血清皮质醇及C‐反应蛋白（CPR）的浓度。记录术后2、12、24和48 h的 VAS疼痛评分、镇痛泵按压次数及镇痛相关并发症。结果 B、C组 T2‐T4时的 MAP和 HR低于 A组（P＜0．05），C组T1‐T4时的MAP和 HR高于B组（P＜0．05）。B、C组术后各时间点皮质醇、CRP浓度均低于A组（P＜0．05），VAS评分和镇痛泵按压次数少于A组（P＜0．05）。A、B、C组出现镇痛相关并发症的例数分别为5例、3例、0例。结论超声引导下连续PV NB或连续硬膜外阻滞复合全身麻醉均能有效减轻胸腔镜肺大泡切除术患者的应激反应，术中血流动力学平稳，术后镇痛效果好。
목적：탐토초성인도하련속추방신경조체（PVNB）복합전신마취대흉강경폐대포절제술응격반응적영향。방법택기행흉강경하폐대포절제술환자60례수궤균분위삼조：A조단순전신마취，술후정맥자공진통；B조련속경막외조체복합전신마취，술후련속경막외진통；C조초성인도하련속PVNB복합전신마취，술후련속PVNB진통。기록마취전（T0）、추방혹경막외급약15 min후（T1）、기관삽관후（T2）、절피후5 min（T3）화술필（T4）적MAP화 HR。검측술전、술후2、12、24화48 h혈청피질순급C‐반응단백（CPR）적농도。기록술후2、12、24화48 h적 VAS동통평분、진통빙안압차수급진통상관병발증。결과 B、C조 T2‐T4시적 MAP화 HR저우 A조（P＜0．05），C조T1‐T4시적MAP화 HR고우B조（P＜0．05）。B、C조술후각시간점피질순、CRP농도균저우A조（P＜0．05），VAS평분화진통빙안압차수소우A조（P＜0．05）。A、B、C조출현진통상관병발증적례수분별위5례、3례、0례。결론초성인도하련속PV NB혹련속경막외조체복합전신마취균능유효감경흉강경폐대포절제술환자적응격반응，술중혈류동역학평은，술후진통효과호。
Objective To explore the influence of ultrasound‐guided continuous paravertebral nerve block (PVNB ) combined with general anesthesia (GA ) on stress response in the patients undergoing pulmonary bulla resection under thoracoscopy .Methods Sixty patients undergoing thoracoscopic pulmonary bulla resection were equally randomized into three groups of A (GA alone) , B(combined use of GA and continuous epidural block) and C(combined use of GA and PVNB) .The postoperative analgesia was performed with patient‐controlled intravenous analgesia in group A , epidural analgesia in goup B and PVNB in group C .MAP and HR were recorded before anesthesia (T0) ,at 15 min after paravertebral or epidural administration(T1) ,after intubation(T2) ,at 5 min after skin incision(T3) and at the end of operation (T4) .Serum levels of cortisol and C‐reactive protein (CPR) were detected before and at 2 ,12 ,24 and 48 hours after operation and VAS pain scores were evaluated as well .Results MAP and HR at T2 to T4 were lower in groups of B and C than those in group A(P<0 .05) ,which at T1 to T4 were higher in group C than those in group B (P<0 .05) . Serum levels of cortisol and CRP ,VAS scores and PCA numbers after operation were less in groups of B and C than those in group A(P<0 .05) .The number of case with analgesia‐related complication in groups of A ,B and C were 5 ,3 and 0 .Conclusion Combined use of ultrasound‐guided continuous PVNB or continuous epidural block and GA can both reduce the stress response and keep circulation stable in the patients undergoing thoracoscopic pulmonary bulla resection .