不同神经阻滞方法对胸腔镜肺癌根治术患者血流动力学的影响

目的 探讨不同神经阻滞方法对胸腔镜肺癌根治术患者术中血流动力学的影响。方法 回顾性分析行择期胸腔镜下肺癌根治术210例患者的临床资料。按其麻醉方法不同分为三组：胸椎旁神经阻滞复合全身麻醉组（A组）、胸段硬膜外阻滞复合全身麻醉组（B组）和单纯全身麻醉组（C组）。A组行超声引导下T4-5椎旁神经阻滞：0.5%罗哌卡因+地塞米松5 mg 20 mL；B组行T5-6或T6-7间隙硬膜外穿刺，硬膜外注射1.4%利多卡因5 mL；C组无特殊处置。比较各组手术时间，术中出血量、输液量等术中情况；统计丙泊酚和瑞芬太尼用量；监测入室时（T₀），麻醉诱导后5 min（T₁），手术开始时（T₂），手术开始后20 min（T₃），清醒即刻（T₄）各时间点患者平均动脉压，心率。比较三组去甲肾上腺素使用时间及用量。结果 A组较C组瑞芬太尼使用量减少，差异有统计学意义，P<0.05。与T₀时比较A、B两组患者T₁、T₂、T₃时平均动脉压显著降低（P<0.05），但A、B两组间比较差异无统计学意义，与C组比较差异有统计学意义。麻醉诱导后3组患者心率都有所下降，手术开始时及清醒即刻三组患者心率比较差异有统计学意义，B组心率下降更明显，A组次之。A、B两组患者去甲肾上腺素使用时间及使用量差异无统计学意义，C组患者去甲肾上腺素使用时间及使用量明显减少，差异有统计学意义。结论 与硬膜外阻滞复合全麻相比，胸椎旁神经阻滞复合全麻也会引起胸腔镜肺癌根治术患者血压下降。

Effects of different nerve block methods on hemodynamics in thoracic surgery

Objective To investigate the effects of different nerve block methods on hemodynamics during thoracoscopic radical resection of lung cancer. Methods A retrospective analysis was performed on 210 patients, who underwent thoracoscopic radical resection of lung cancer. According to the anesthesia methods, the patients were divided into three groups:thoracic paravertebral nerve block combined with general anesthesia group (group A), thoracic epidural analgesia combined with general anesthesia group (group B), and general anesthesia group (group C). Ultrasound-guided T4-5 paravertebral nerve block was performed in group A using 0.5% ropivacaine + dexamethasone 5 mg 20 mL; in group B, T5-6 or T6-7 interval epidural puncture was performed and 1.4% lidocaine 5 mL was injected into epidural space, and in group C, no special treatment was given. Comparison of operation time, intraoperative blood loss, infusion volume and other intraoperative conditions was performed. Dosage of propofol and remifentanil was monitored. The mean arterial pressure and heart rate of patients at the time of entry (T₀), 5 minutes after anesthesia induction (T₁), the beginning of surgery (T₂), 20 minutes after surgery (T₃), and the time of awake (T₄) were recorded. Results Compared with T₀, the mean arterial pressures at T₁, T₂ and T₃ were significantly lower in the A and B groups (P<0.05), but there was no significant difference between the two groups. There was no significant difference in the time and amount of norepinephrine used between the A and B groups. The use of remifentanil in group A was lower than that in group C, and the difference was statistically significant. Conclusion Compared with epidural analgesia combined with general anesthesia, thoracic paraspinal nerve block combined with general anesthesia can also cause blood pressure drop in patients undergoing thoracoscopic radical resection of lung cancer.