肋间神经阻滞联合全身麻醉对微创二尖瓣手术患者应激反应的影响。
Effect of intercostal nerve block combined with general anesthesia on the stress response in patients undergoing minimally invasive mitral valve surgery.
作者信息
Zhan Yanping, Chen Guo, Huang Jian, Hou Benchao, Liu Weicheng, Chen Shibiao
机构信息
Department of Anesthesia, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.
Department of Reproductive Health, Jiangxi Province Maternal and Child Health Care Hospital, Nanchang, Jiangxi 330046, P.R. China.
出版信息
Exp Ther Med. 2017 Oct;14(4):3259-3264. doi: 10.3892/etm.2017.4868. Epub 2017 Aug 2.
The aim of the present study was to investigate the effect of intercostal nerve block combined with general anesthesia on the stress response and postoperative recovery in patients undergoing minimally invasive mitral valve surgery (MIMVS). A total of 30 patients scheduled for MIMVS were randomly divided into two groups (n=15 each): Group A, which received intercostal nerve block combined with general anesthesia and group B, which received general anesthesia alone. Intercostal nerve block in group A was performed with 0.5% ropivacaine from T3 to T7 prior to anesthesia induction. In each group, general anesthesia was induced using midazolam, sufentanil, propofol and vecuronium. Central venous blood samples were collected to determine the concentrations of cortisol, glucose, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at the following time points: During central venous catheterization (T), 5 min prior to cardiopulmonary bypass (T), perioperative (T) and 24 h following surgery (T). Clinical data, including parameters of opioid (sufentanil) consumption, time of mechanical ventilation, duration of intensive care unit (ICU) stay, visual analog scale scores and any complications arising from intercostal nerve block, were recorded. Levels of cortisol, glucose, IL-6 and TNF-α in group A were significantly lower than those in group B at T (all P<0.001; cortisol, P<0.05), T (all P<0.001) and T (all P<0.001; glucose, P<0.05), suggesting that intercostal nerve block combined with general anesthesia may inhibit the stress response to MIMVS. Additionally, intercostal nerve block combined with general anesthesia may significantly reduce sufentanil consumption (P<0.001), promote early tracheal extubation (P<0.001), shorten the duration of ICU stay (P<0.01) and attenuate postoperative pain (P<0.001), compared with general anesthesia alone. Thus, these results suggest that intercostal nerve block combined with general anesthesia conforms to the concept of rapid rehabilitation surgery and may be suitable for clinical practice.
本研究旨在探讨肋间神经阻滞联合全身麻醉对微创二尖瓣手术（MIMVS）患者应激反应及术后恢复的影响。总共30例计划行MIMVS的患者被随机分为两组（每组n = 15）：A组接受肋间神经阻滞联合全身麻醉，B组仅接受全身麻醉。A组在麻醉诱导前用0.5%罗哌卡因从T3至T7进行肋间神经阻滞。每组均使用咪达唑仑、舒芬太尼、丙泊酚和维库溴铵诱导全身麻醉。在以下时间点采集中心静脉血样本以测定皮质醇、葡萄糖、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的浓度：中心静脉置管期间（T₁）、体外循环前5分钟（T₂）、围手术期（T₃）和术后24小时（T₄）。记录临床数据，包括阿片类药物（舒芬太尼）用量参数、机械通气时间、重症监护病房（ICU）住院时间、视觉模拟评分以及肋间神经阻滞引起的任何并发症。在T₁（所有P < 0.001；皮质醇，P < 0.05）、T₂（所有P < 0.001）和T₃（所有P < 0.001；葡萄糖，P < 0.05）时，A组的皮质醇、葡萄糖、IL-6和TNF-α水平显著低于B组，这表明肋间神经阻滞联合全身麻醉可能抑制MIMVS的应激反应。此外，与单纯全身麻醉相比，肋间神经阻滞联合全身麻醉可显著减少舒芬太尼用量（P < 0.001），促进早期气管拔管（P < 0.001），缩短ICU住院时间（P < 0.01）并减轻术后疼痛（P < 0.001）。因此，这些结果表明肋间神经阻滞联合全身麻醉符合快速康复手术的理念，可能适用于临床实践。
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