超声引导下胸椎旁神经阻滞在老年糖尿病患者胸腔镜肺癌根治术中的应用

赵玉斌 王刚

[摘要] 目的 分析超声引导下胸椎旁神经阻滞在老年糖尿病患者胸腔镜肺癌根治术中的应用。方法 该次研究对象为我院收治的70例老年糖尿病胸腔镜肺癌根治术患者，患者在2016年9月—2019年7月期间纳入，应用计算机对患者进行随机分为普通组和观察组，普通组给予全麻，观察组在全麻诱导前实施超声引导下胸椎旁神经阻滞，对比两组患者不同时段血糖以及麻醉药物用量。结果 观察组患者在T2、T3、T4、T5时段下，其血糖指标较普通组更低，差异有统计学意义（P<0.05）;观察组患者在T3、T4时段下Cor较普通组更低，数据差异有统计学意义（P<0.05）;观察组患者瑞芬太尼用量为（1 526.2±73.8）μg，舒芬太尼用量为（47.3±4.7）μg，去氧肾上腺素用量为（309.7±52.5）μg，其数据与普通组比较差异有统计学意义（P<0.05）。结论 超声引导下胸椎旁神经阻滞应用于老年糖尿病患者胸腔镜肺癌根治术可减少血糖指标波动，确保手术安全，同时降低麻醉药物用量，有助于改善术后并发症，值得推广应用。

[关键词] 超声引导;胸椎旁神经阻滞;老年糖尿病;胸腔镜肺癌根治术

[Abstract] Objective To analyze the application of ultrasound-guided thoracic paravertebral nerve block in thoracoscopic radical mastectomy for elderly patients with diabetes. Methods This study was performed on 70 elderly patients undergoing radical thoracoscopic lung cancer surgery in the hospital. The patients were included in the group from September 2016 to July 2019. The patients were randomly divided into ordinary groups and observed using computer. The general group was given general anesthesia， and the observation group underwent ultrasound-guided parathoracic nerve block before the induction of general anesthesia. The blood glucose and the number of anesthetic drugs were compared between the two groups at different periods. Results The patients in the observation group had lower blood glucose indexes than the ordinary group at T2， T3， T4， and T5 periods， and the difference was statistically significant（P<0.05）. The patients in the observation group had more Cor at T3 and T4 periods than the ordinary group. The data difference was statistically significant（P<0.05）. The dosage of remifentanil in the observation group was （1 526.2±73.8）μg， the amount of sufentanil was （47.3±4.7）μg， and the amount of phenylephrine was （309.7±52.5）μg， the data was statistically significant compared with the ordinary group（P<0.05）. Conclusion Ultrasound-guided thoracic paravertebral nerve block can be applied to the radical operation of thoracoscopic lung cancer in elderly diabetic patients， which can reduce the fluctuation of blood glucose indexes， ensure the safety of the operation， and reduce the number of anesthetic drugs.

[Key words] Ultrasound guidance; Thoracic paravertebral nerve block; Senile diabetes; Thoracoscopic radical surgery for lung cancer

近几年，我国人口逐步老龄化发展，糖尿病患者数量不断升高，加之生态环境的改变，进一步导致了各类恶性肿瘤疾病发病率的上升[1]。糖尿病合并肺癌在采用手术治疗的過程中，对麻醉操作有着较高的要求，其主要目的在于降低应激反应，同时稳定血糖，确保手术安全，减少术后并发症[2]。糖尿病患者血糖指标如果持续异常，在高血糖状态下进行手术，会进一步加重感染以及神经损伤风险，因此在术中需要采取合理的麻醉方式。文章将对超声引导下胸椎旁神经阻滞在老年糖尿病患者胸腔镜肺癌根治术中的应用进行分析，并选取了2016年9月—2019年7月期间纳入的70例老年糖尿病胸腔镜肺癌根治术患者进行观察，现报道如下。