趙玉斌 王剛

[摘要] 目的 分析超聲引導(dǎo)下胸椎旁神經(jīng)阻滯在老年糖尿病患者胸腔鏡肺癌根治術(shù)中的應(yīng)用。方法 該次研究對(duì)象為我院收治的70例老年糖尿病胸腔鏡肺癌根治術(shù)患者，患者在2016年9月—2019年7月期間納入，應(yīng)用計(jì)算機(jī)對(duì)患者進(jìn)行隨機(jī)分為普通組和觀察組，普通組給予全麻，觀察組在全麻誘導(dǎo)前實(shí)施超聲引導(dǎo)下胸椎旁神經(jīng)阻滯，對(duì)比兩組患者不同時(shí)段血糖以及麻醉藥物用量。結(jié)果 觀察組患者在T2、T3、T4、T5時(shí)段下，其血糖指標(biāo)較普通組更低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;觀察組患者在T3、T4時(shí)段下Cor較普通組更低，數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;觀察組患者瑞芬太尼用量為（1 526.2±73.8）μg，舒芬太尼用量為（47.3±4.7）μg，去氧腎上腺素用量為（309.7±52.5）μg，其數(shù)據(jù)與普通組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 超聲引導(dǎo)下胸椎旁神經(jīng)阻滯應(yīng)用于老年糖尿病患者胸腔鏡肺癌根治術(shù)可減少血糖指標(biāo)波動(dòng)，確保手術(shù)安全，同時(shí)降低麻醉藥物用量，有助于改善術(shù)后并發(fā)癥，值得推廣應(yīng)用。

[關(guān)鍵詞] 超聲引導(dǎo);胸椎旁神經(jīng)阻滯;老年糖尿病;胸腔鏡肺癌根治術(shù)

[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

近幾年，我國(guó)人口逐步老齡化發(fā)展，糖尿病患者數(shù)量不斷升高，加之生態(tài)環(huán)境的改變，進(jìn)一步導(dǎo)致了各類惡性腫瘤疾病發(fā)病率的上升[1]。糖尿病合并肺癌在采用手術(shù)治療的過(guò)程中，對(duì)麻醉操作有著較高的要求，其主要目的在于降低應(yīng)激反應(yīng)，同時(shí)穩(wěn)定血糖，確保手術(shù)安全，減少術(shù)后并發(fā)癥[2]。糖尿病患者血糖指標(biāo)如果持續(xù)異常，在高血糖狀態(tài)下進(jìn)行手術(shù)，會(huì)進(jìn)一步加重感染以及神經(jīng)損傷風(fēng)險(xiǎn)，因此在術(shù)中需要采取合理的麻醉方式。文章將對(duì)超聲引導(dǎo)下胸椎旁神經(jīng)阻滯在老年糖尿病患者胸腔鏡肺癌根治術(shù)中的應(yīng)用進(jìn)行分析，并選取了2016年9月—2019年7月期間納入的70例老年糖尿病胸腔鏡肺癌根治術(shù)患者進(jìn)行觀察，現(xiàn)報(bào)道如下。