自体肋软骨移植外耳再造术中超声引导胸椎旁神经阻滞麻醉的应用

 目的 探讨超声引导胸椎旁神经阻滞在自体肋软骨移植外耳再造术中的应用。方法 选取2018-05至2019-11武警山东总队医院择期行肋软骨移植外耳再造Ⅱ期手术的患儿60例,随机分为单纯全身麻醉组(A组)30例,全身麻醉复合椎旁神经阻滞组(B组)30 例。观察两种麻醉方式在外耳再造术中的麻醉效果、术后镇痛、术中全麻药物用量及术后不良反应等方面的差异。结果 B组术中使用1%异丙酚(725.69±145.50)mg,瑞芬太尼(2129.90±536.72)μg, 明显少于A组异丙酚(914.58±242.41)mg,瑞芬太尼(3266.79±770.64)μg,差异有统计学意义(P<0.05);B组在切皮时(H₂)、取软骨时(H₃)及拔除气管导管时(H₄)的心率和血压、术后6 h内VAS评分均明显低于A组,差异有统计学意义(P<0.05);B组术后苏醒时间(T₀)为(11.53±1.43)min,明显短于A组的(15.00±1.46)min,差异有统计学意义(P<0.05);B组发生心血管、恶心呕吐、便秘等不良反应明显少于A组,差异有统计学意义(P<0.05)。结论 超声引导胸椎旁神经阻滞复合全身麻醉应用于自体肋软骨移植外耳再造术,术中麻醉效果显著,血流动力学更加稳定,全麻药物用量少,术后镇痛效果明显,适合临床应用。

Application of ultrasound-guided paravertebral nerve block in reconstruction of external ears with autogenous costal cartilage transplantation

Objective To study the applicability of ultrasound-guided thoracic paravertebral nerve block in external ear reconstruction with autogenous costal cartilage transplantation.Methods Between May 2018 and November 2019, 60 children in the second stage of external ear reconstruction with costal cartilage transplantation were randomly divided into the general anesthesia group (group A) and paravertebral nerve block group (group B). The difference in anesthetic effect, postoperative analgesia, intraoperative general anesthesia dosage and postoperative adverse reactions was observed between the two anesthetic methods for external ear reconstruction.Results 1% propofol (725.69±145.50)mg and remifentanil (2129.90±536.72)μg were used in group B, while propofol (914.58±242.41)mg and remifentanil (3266.79±770.64)μg were used group A. The usage of the two drugs was significantly less in group B than in group A (P<0.05). The heart rate and blood pressure responses of group B were significantly lower than those of group A. The recovery time (T₀)was (15.00±1.46)min in group A and(11.53±1.43)min in group B, which was significantly shorter than in group A (P<0.05). The incidence of such adverse reactions as cardiovascular events, nausea, vomiting and constipation was significantly lower in group B than in group A (P<0.05).Conclusions Ultrasound-guided thoracic paraspinal nerve block combined with general anesthesia has been applied to the reconstruction of external ears with autogenous costal cartilage transplantation. Compared with general anesthesia alone, the anesthetic effect of this approach is significant during operation. The hemodynamics is more stable. The dosage of drugs for general anesthesia is significantly reduced. The advantages of postoperative analgesia are obvious, recovery is faster, and there are fewer adverse reactions.