标题：七氟烷复合丙泊酚联合椎旁神经阻滞对胸腔镜肺大疱切除术患者血流动力学及氧化应激的影响

      作者：赵丽，黄宏艳，金婷    深圳市盐田区人民医院麻醉科，广东 深圳 518081

      卷次： 2020年31卷2期

      【摘要】 目的 研究七氟烷复合丙泊酚联合椎旁神经阻滞对胸腔镜肺大疱切除术患者血流动力学及氧化应激的影响。方法 前瞻性选取深圳市盐田区人民医院2016年12月至2019年1月收治的98例胸腔镜肺大疱切除术患者作为研究对象，按随机数表法将其分为观察组与对照组，每组49例。观察组患者采取七氟烷复合丙泊酚全麻联合椎旁神经阻滞麻醉，维持全麻前(即患者清醒时)，测定神经阻滞范围，而后使用超声引导，在患者所需开胸切口之胸椎旁注射0.5%罗哌卡因12~15 mL；对照组患者采用单纯全身麻醉方式。所有患者胸腔镜肺大疱切除术后缝皮时均使用静脉自控镇痛泵。比较两组患者在麻醉前(T0)、手术开始30 min后(T1)、术毕(T2)、术后1 h (T3)时检测的白细胞介素(IL)-6和 IL-10的浓度。观察患者术后2 h、12 h、24 h以及48 h的视觉模拟量表(VAS)评分。比较两组患者的氧化应激、血流动力学指标以及术后不良反应发生情况。结果 T1~T3时两组患者的白细胞介素 IL-6浓度和 IL-10浓度与麻醉前(T0)比较均明显升高，差异均有统计学意义(P<0.05)；但T1~T3时观察组患者的白细胞介素 IL-6浓度明显低于对照组，IL-10浓度明显高于对照组，差异均具有统计学意义(P<0.05)；T1、T2时两组患者的平均动脉差(MAP)水平与T0时相比明显降低，心率(HR)水平较T0时明显减慢，且T1、T2时观察组患者的MAP、HR水平与对照组比较差异均具有统计学意义(P<0.05)；观察组患者术后2 h、12 h、24 h以及48 h的VAS评分明显低于对照组差异均具有统计学意义(P<0.05)；与T0时比较，T1~T3时两组患者的丙二醛(MDA)均有所升高，超氧化物歧化酶(SOD)水平有所降低，差异均具有统计学意义((P<0.05)；T1~T3时，观察组患者的MDA明显低于对照组，SOD水平明显高于对照组，差异均具有统计学意义(P<0.05)；治疗后观察组患者的总不良反应率为4.08%，明显低于对照组的20.40 %，差异具有统计学意义(P<0.05)。结论 七氟烷复合丙泊酚联合椎旁神经阻滞用于胸腔镜肺大疱切除术患者可以有效维持血流动力学稳定，同时减少氧化应激反应，不良反应较少，值得临床推广应用。
      【关键词】 七氟烷；丙泊酚；胸椎旁神经阻滞；胸腔镜手术；肺大疱切除术；血流动力学
      【中图分类号】 R655.3 【文献标识码】 A 【文章编号】 1003—6350（2020）02—0191—05

Effects of sevoflurane combined with propofol and paravertebral nerve block on hemodynamics and oxidativestress in patients undergoing thoracoscopic bullectomy.
ZHAO Li, HUANG Hong-yan, JIN Ting. Department ofAnesthesiology, Shenzhen Yantian District People's Hospital, Shenzhen 518081, Guangdong, CHINA
【Abstract】 Objective To study the effects of sevoflurane combined with propofol combined with paravertebralnerve block on hemodynamics and oxidative stress in patients undergoing thoracoscopic bullectomy. Methods A totalof 98 patients undergoing thoracoscopic bullectomy who were admitted to Shenzhen Yantian District People's Hospitalfrom December 2016 to January 2019 were enrolled as subjects. They were divided into observation group and controlgroup according to the random number table method, with 49 patients in each group. Patients in the observation groupwere treated with sevoflurane combined with propofol and paravertebral block for anesthesia. Before the maintenance ofgeneral anesthesia (that is, when the patients were awake), the nerve block range was measured, and then 12~15 mL of0.5% ropivacaine was injected into the thoracic vertebrae of patients with thoracotomy under the guidance of ultrasound.The control group was treated with general anesthesia. Patient controlled intravenous analgesia pump was used in all pa-tients after thoracoscopic bullectomy. The concentrations of interleukin (IL)-6 and IL-10 were measured between thetwo groups before anesthesia (T0), 30 minutes after surgery (T1), at the end of surgery (T2), and 1 hour after surgery(T3). The Visual Analogue Scale (VAS) scores of the patients at 2 h, 12 h, 24 h and 48 h after operation were compared.The oxidative stress, hemodynamic parameters, and postoperative adverse reactions were compared between the twogroups. Results The levels of IL-6 and IL-10 in the two groups were significantly higher than those before anesthesia(T0) at T1, T2, T3 (P<0.05); but at T1, T2, T3, the level of IL-6 in the observation group was significantly lower thanthat in the control group, and the level of IL-10 was significantly higher than that in the control group (P<0.05). At T1and T2, the mean arterial difference (MAP) level of the two groups was significantly lower than that of T0, and the heartrate (HR) was significantly slower than at T0; at T1 and T2, MAP and HR showed statistically significant difference be-