在非输入管和输入管视频辅助胸部手术中,术内胸腔镜间肋骨神经阻塞的有效性:一项随机研究
Kuang-Cheng Chan1, Li-Lin Wu2, Su-Chuan Han2
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
概括
胸腔镜间肋间神经阻塞 (TINBs) 减少了视频辅助胸部手术 (VATS) 中的麻醉需求. 非输管的VATS (NIVATS) 需要更少的雷米芬坦尼尔,但具有更高的低血压风险,需要仔细监测.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
背景情况:
- 对视频辅助胸部手术 (VATS) 疼痛进行胸腔镜间隔神经阻塞 (TINBs) 的有效性尚不清楚.
- 在非输入管的VATS (NIVATS) 和输入管的VATS (IVATS) 之间,TINB疗效的潜在差异是未知的.
研究的目的:
- 为了比较TINBs在NIVATS和IVATS中的手术内止痛和镇静疗效.
- 评估TINBs对VATS程序期间麻醉要求的影响.
主要方法:
- 接受VATS的60名患者被随机分配到NIVATS或IVATS.
- 两个小组都接受了propofol和remifentanil输液,在手术前给予TINBs.
- 术内数据,包括BIS,MAP,HR和药物度,使用双向ANOVA进行监测和分析.
主要成果:
- 密度光谱阵列 (DSA) 监测显示,在两组中,爆发抑制后的TINBs.
- 在TINBs之后,普罗波福和雷米芬坦尼尔的需求减少了.
- 在NIVATS中,雷米芬坦尼尔输液显著降低,与较高的低血压风险相关.
结论:
- 在外科手术中使用的TINB有效地减少了VATS的麻醉和止痛需求.
- 与TINBs一起使用的NIVATS由于更低的雷米芬坦尼尔需求而增加了低血压风险.
- DSA监控有助于实时管理,特别是对于NIVATS.
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