目的 探讨胸腔镜直视下肋间神经微穿刺注射及T8-9硬膜外阻滞联合羟考酮(Thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block combined with oxycodone,T-E-O)三联法用于胸腹腔镜食管癌根治术后苏醒期镇痛及呼吸恢复的效果.方法 择期行胸腹腔镜食管癌根治术患者140例,ASA分级Ⅰ或Ⅱ级.随机分为2组(n=70):对照组(C组)和T-E-O三联法组(T组).术毕前10 min静脉注射舒芬太尼0.1 μg/kg(C组)或羟考酮0.1 mg/kg(T组),T组麻醉诱导前T8-9硬膜外阻滞,关胸前罗哌卡因胸腔内肋间神经微穿刺注射麻醉.术毕均送入麻醉后监护病房(PACU),苏醒后拔管送入病房.术后舒芬太尼(C组)或羟考酮(T组)行静脉自控镇痛(PCIA).术后静脉注射舒芬太尼0.05 μg/kg(C组)或羟考酮0.05 mg/kg(T组)用于镇痛补救,维持VAS≤3分.于单肺通气(OLV)前1min(t0)、恢复双肺通气前(t1)、恢复双肺通气后30min(t2)、入PACU后(t3)、拔管前(t4)、拔管后疼痛时(t5)、镇痛药补救后(t6)、出PACU(t7)时进行血气分析,计算氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)及呼吸指数(RI),收集PACU期间补救镇痛药物次数、苏醒时间、气管拔管时间和PACU停留时间,记录肺功能异常及躁动发生情况.结果 与C组比较,T组t5-7时OI升高,A-aDO2和RI降低(P＜0.05),拔管时间、PACU停留时间缩短,补救镇痛次数、肺功能异常率及躁动发生率明显降低(P＜0.05).结论 T-E-O三联法在胸腹腔镜食管癌根治术后苏醒期可明显缓解疼痛,改善呼吸功能.
Effect of thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block combined with oxycodone(T-E-O)triple process on analgesia and respiratory recovery after radical resection of thoracic laparoscopic esophageal cancer
Objective To study the effects of thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block combined with oxycodone(T-E-O)triple process on analgesia and respiratory recovery after radical resection of esophageal cancer by thoracic laparoscopy.Methods One hundred and forty patients of both sexes,of American Society of Anesthesiologists(ASA)physical status Ⅰ or Ⅱ,were scheduled for elective radical resection of esophageal cancer undergoing thoracoscope and laparoscopic radical surgery of esophageal cancer,and then were randomly divided into 2 groups(n=70 each):a control group(group C)and a T-E-O triple process group(group T).Sufentanil 0.1 μg/kg in group C or oxycodone 0.1 mg/kg in group T were intravenously injected at 10 min before the end of operation.T8-9 epidural block was applied before anesthesia induction,and thoracoscopic direct vision intercostal nerve micropuncture injection in the chest before closing chest was performed.All patients sent to Postanesthesia Care Unit(PACU)after surgery were extubated and sent to ward after resuscitation.Analgesic pump was connected at the end of operation in two groups.Sufentanil 0.05 μg/kg in group C or oxycodone 0.05 mg/kg in group T were intravenously injected when visual analogue scale score(VAS)≤ 3.At lmin before one-lung ventilation(OLV)(t0),before re-expansion of the collapsed lung(t1),at 30 min after re-expansion of the collapsed lung(t2),into PACU(t3),before extubation(t4),pain after extubation(t5),after the analgesic injection(t6),when leaving PACU(t7),blood gas analysis was performed,oxygenation index(OI),alveolar-arterial oxygen gradient(A-aDO2)and respiratory index(RI)were calculated,the number of rescue analgesia when in PACU,the recovery time,tracheal extubation time and PACU residence time were collected,the occurrence of abnormal lung function and agitation were recorded.Results Compared with group C,OI was significantly increased,A-aDO2 and RI was reduced at t5-7(P＜0.05),and the number of requirements for rescue analgesia,the recovery time,tracheal extubation time and PACU residence time,the occurrence of abnormal lung function and agitation were decreased in group T(P＜0.05).Conclusions T-E-O triple process can significantly relieve pain and improve respiratory function during the recovery period after radical laparoscopic surgery for esophageal cancer.
Intercostal nerve blockEpidural blocksOxycodoneRadical surgery of esophageal canceryPainRespiratory index
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维普
