{"title":"胸腔镜肺叶切除术患者椎旁阻滞降低体温:一项随机对照试验。","authors":"Yanhong Yan, Jiao Geng, Xu Cui, Guiyu Lei, Lili Wu, Guyan Wang","doi":"10.2147/TCRM.S392961","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use.</p><p><strong>Patients and methods: </strong>Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T<sub>0</sub>) and every 15 min thereafter (T<sub>1</sub>-T<sub>8</sub>), and the end of surgery (T<sub>p</sub>). The primary outcome was the lower esophageal temperature at T<sub>p</sub>. The secondary outcomes included lower esophageal temperature from T<sub>0</sub>-T<sub>8</sub> and axillary temperature from T<sub>0</sub>-T<sub>p</sub>. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded.</p><p><strong>Results: </strong>Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001).</p><p><strong>Conclusion: </strong>Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.</p>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/a1/tcrm-19-67.PMC9880011.pdf","citationCount":"3","resultStr":"{\"title\":\"Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial.\",\"authors\":\"Yanhong Yan, Jiao Geng, Xu Cui, Guiyu Lei, Lili Wu, Guyan Wang\",\"doi\":\"10.2147/TCRM.S392961\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use.</p><p><strong>Patients and methods: </strong>Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T<sub>0</sub>) and every 15 min thereafter (T<sub>1</sub>-T<sub>8</sub>), and the end of surgery (T<sub>p</sub>). The primary outcome was the lower esophageal temperature at T<sub>p</sub>. The secondary outcomes included lower esophageal temperature from T<sub>0</sub>-T<sub>8</sub> and axillary temperature from T<sub>0</sub>-T<sub>p</sub>. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded.</p><p><strong>Results: </strong>Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001).</p><p><strong>Conclusion: </strong>Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. 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引用次数: 3
摘要
目的:胸椎旁阻滞(TPVB)可能对胸腔镜肺叶切除术患者非常有益，但它可能增加低体温的风险。除了其镇痛作用外，本随机对照试验旨在研究TPVB的降体温作用，从而优化其临床应用。患者和方法:将成年患者随机分为TPVB +全身麻醉(GA)组和GA组。在TPVB+GA组中，在GA诱导后由经验丰富但无关的麻醉师进行阻滞。术前(T0)、术后每15 min (T1-T8)及手术结束(Tp)分别记录食管下段和腋窝温度。主要结局是Tp时食管温度降低。次要结果包括T0-T8期食管温度降低和T0-Tp期腋窝温度降低。同时记录丙泊酚、镇痛药和去甲肾上腺素的总用量及不良事件的发生率。结果:48例患者随机分为TPVB+GA组(n=24)和GA组(n=24)。TPVB+GA组手术结束时的核心温度低于GA组(35.90±0.30°C vs 36.35±0.33°C)。结论:虽然采用了彻底的升温策略，但TPVB联合GA明显降低了体温，这是一个容易被忽视的副作用。需要进一步研究最有效的预防措施，以优化TPVB的临床应用。
Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial.
Purpose: Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use.
Patients and methods: Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T0) and every 15 min thereafter (T1-T8), and the end of surgery (Tp). The primary outcome was the lower esophageal temperature at Tp. The secondary outcomes included lower esophageal temperature from T0-T8 and axillary temperature from T0-Tp. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded.
Results: Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001).
Conclusion: Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.
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