超声引导罗哌卡因喉上神经内支阻滞对喉癌切除术后功能康复的影响

    Effect of ultrasound-guided ropivacaine internal branch block on the functional rehabilitation after laryngeal carcinoma resection

    • 摘要:
      目的: 研究超声引导罗哌卡因喉上神经内支阻滞对喉癌切除术后功能康复的影响。
      方法: 76例喉癌病人随机分为对照和观察组,各38例。均行支撑喉镜下喉癌切除术,对照组术中进行常规麻醉,观察组在此基础上采用超声引导下罗哌卡因喉上神经内支阻滞进行麻醉。2组均观察至术后48 h(T5)。统计2组麻醉药物及血管活性药物使用剂量及术后观察期间不良反应发生情况,比较2组入室时(T0)、气管插管即刻(T1)、切皮后30 min(T2)和出室时(T3)生命体征,T0、术后24 h(T4)应激反应和炎症指标以及T5功能康复情况。
      结果: 观察组瑞芬太尼、丙泊酚用量低于对照组(P < 0.05)。T0、T1、T2和T3,HR呈先升高后降低趋势(P < 0.05)。对照组T1、T2和T3 SBP、DBP均高于T0,T2 SBP低于T1,T3 DBP低于T1P < 0.05);观察组T2、T3 SBP低于T1,T2 DBP低于T1,T1高于T0,T3高于T2P < 0.05);观察组T1、T2、T3 HR、SBP低于对照组,T1、T2 DBP低于对照组(P < 0.05)。T4 2组血清Cor、ACTH、IL-6和CRP水平与T0比较升高,但观察组低于对照组(P < 0.05)。T5 2组角色、社会、躯体、情感和知评分均比T0升高,观察组高于对照组(P < 0.05)。术后观察期间,2组总不良反应发生率差异无统计学意义(P > 0.05)。
      结论: 超声引导下罗哌卡因喉上神经内支阻滞可减少喉癌切除术病人麻醉药物的使用,改善病人生命体征,降低机体应激、炎症反应,促进病人功能康复,具有较好的麻醉效果,同时不会增加不良反应的发生。

       

      Abstract:
      Objective To investigate the effects of ultrasound-guided ropivacaine internal branch block on the functional rehabilitation after laryngeal carcinoma resection.
      Methods Seventy-six patients with laryngeal cancer were randomly divided into the control group (38 cases) and observation group (38 cases). All patients were treated with laryngeal carcinoma resection under supportive laryngoscope. The control group received conventional anesthesia during the operation, while the observation group was anesthetized by ultrasound-guided ropivacaine block of the internal branch of the superior laryngeal nerve on this basis. Both groups were observed until 48 hours after operation (T5). The dosages of anesthetic drugs and vasoactive drugs used in two groups and occurrence of adverse reactions during the postoperative observation period were statistically analyzed. The vital signs at the time of entering the room (T0), immediately after tracheal intubation (T1), 30 minutes after skin incision (T2) and leaving the room (T3), stress responses and inflammatory indicators at T0 and after 24 hours of operation (T4), and functional recovery at T5 were compared between two groups.
      Results The dosage of remifentanil and propofol in the observation group was lower than those in control group (P < 0.05). At T0, T1, T2 and T3, the HR increased first and then decreased (P < 0.05). In the control group, the SBP and DBP at T1, T2 and T3 were higher than those at T0, the SBP at T2 was lower than that at T1, and the DBP at T3 was lower than that at T1 (P < 0.05). In the observation group, the SBP at T2 and T3 was lower than that at T1, the DBP at T2 was lower than that at T1, the DBP at T1 was higher than that at T0, and the DBP at T3 was higher than that at T2 (P < 0.05). The HR and SBP at T1, T2 and T3 in the observation group were lower than those in control group, and the DBP at T1 and T2 in the observation group were lower than those in control group (P < 0.05). The serum levels of Cor, ACTH, IL-6 and CRP in the two groups at T4 were higher than those at T0, but whose in the observation group were lower than those in control group (P < 0.05). The scores of role, society, body, emotion and knowledge in the two groups at T5 were higher than those at T0, and the scores in the observation group were higher than those in the control group (P < 0.05). During the postoperative observation period, there was no statistical significance in the incidence of total adverse reactions between two groups (P > 0.05).
      Conclusions Ultrasound-guided ropivacaine block of the internal branch of the superior laryngeal nerve can reduce the use of anesthetic drugs in patients with laryngeal cancer resection, improve the vital signs of patients, reduce the body's stress and inflammatory responses, promote the functional recovery of patients, have a better anesthetic effect, and at the same time will not increase the occurrence of adverse reactions.

       

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