胸外科患者围手术期血流动力学指标的变化

H. Poniatovska, S. Dubrov
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There were included 180 patients with lung cancer who underwent thoracotomy at the Kyiv City Clinical Hospital No. 17 from 2018 to 2021 within an open noncommercial randomized controlled clinical trial. Patients were randomized into four groups. Multimodal analgesia (MA) group: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Thoracic epidural anagesia (TEA) group: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours.\nControl (C) group: patients received dexketoprofen 50 mg intravenous and opioid analgesic intramuscularly as needed.\nResults. There were not observed any statistically significant differences in the groups by age, height, weight, degree of anesthetic risk (ASA), blood loss, duration and volume of surgery (p>0.05). A 10-15% decrease in hemodynamics was noted after epidural support with subsequent need for infusion therapy prior to induction of general anesthesia. An increase of the frequency of manifestations of hypotension, itching at the injection site, and urinary retention were observed in the MA and TEA groups in the postoperative period.\nConclusion. 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引用次数: 0

摘要

介绍。covid - 19大流行导致肿瘤疾病的诊断和早期发现延迟,未来将伴随新癌症病例登记的短期减少,然后手术干预的数量增加,包括呼吸器官手术。胸外科手术的麻醉支持包括围手术期氧合和血流动力学参数的控制,这些参数的改变会对术后时间产生负面影响,并增加围手术期并发症的发生频率。目的:通过对血流动力学和氧合指标的评价,探讨手术中不同围手术期麻醉方式对呼吸器官的影响。材料和方法。在一项开放的非商业性随机对照临床试验中,纳入了2018年至2021年在基辅市第17临床医院接受开胸手术的180名肺癌患者。患者随机分为四组。多模式镇痛(MA)组:按照先发制人镇痛的理念,切口前1小时-患者静脉给予扑热息痛1000 mg,同时静脉给予右酮洛芬50 mg,术后每8小时给予右酮洛芬和扑热息痛,+硬膜外麻醉:置管时给予2%利多卡因溶液40 mg,术后给予罗哌卡因2 mg/ml (3-14 ml/h)。胸段硬膜外麻醉(TEA)组:硬膜外麻醉:置管时给予2%利多卡因溶液40 mg,术后给予罗哌卡因2 mg/ml (3 ~ 14 ml/h)。先发制人镇痛(PA)组:按照先发制人镇痛的理念,切口前1小时患者静脉给予扑热息痛1000 mg,右酮洛芬50 mg静脉给予,术后每8小时给予右酮洛芬和扑热息痛一次。对照(C)组:患者根据需要给予右酮洛芬50 mg静脉注射和阿片类镇痛药肌注。各组患者年龄、身高、体重、麻醉危险程度(ASA)、出血量、手术时间、手术量差异无统计学意义(p>0.05)。经硬膜外支持后,血流动力学下降10-15%,随后需要在全麻诱导前进行输液治疗。MA组和TEA组术后出现低血压、注射部位瘙痒、尿潴留等症状的频率均有所增加。胸外科硬膜外镇痛术围手术期阴性并发症较多,考虑到氧合指标组间差异无统计学意义(p>0.05),采用不使用硬膜外支持的多模式入路可降低患者复合治疗各阶段并发症发生频率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CHANGES IN HEMODYNAMICS INDICATORS IN THE PERIOPERATIVE PERIOD IN PATIENTS IN THORACIC SURGERY
Introduction. The covid pandemic has caused a delay in diagnosis and early detection of oncological diseases, which in the future will be accompanied by a short-term decrease in the registration of new cancer cases, and then an increase in the number of surgical interventions, including on the respiratory organs. Anesthesiological support in thoracic surgery includes perioperative control of oxygenation and hemodynamic parameters, changes in which can negatively affect the postoperative period and increase the frequency of perioperative complications. Objective: To study the specifics of the impact of various methods of perioperative anesthesia during surgeries on the respiratory organs, using the evaluation of the hemodynamics and oxygenation indicators. Materials and methods. There were included 180 patients with lung cancer who underwent thoracotomy at the Kyiv City Clinical Hospital No. 17 from 2018 to 2021 within an open noncommercial randomized controlled clinical trial. Patients were randomized into four groups. Multimodal analgesia (MA) group: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Thoracic epidural anagesia (TEA) group: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours. Control (C) group: patients received dexketoprofen 50 mg intravenous and opioid analgesic intramuscularly as needed. Results. There were not observed any statistically significant differences in the groups by age, height, weight, degree of anesthetic risk (ASA), blood loss, duration and volume of surgery (p>0.05). A 10-15% decrease in hemodynamics was noted after epidural support with subsequent need for infusion therapy prior to induction of general anesthesia. An increase of the frequency of manifestations of hypotension, itching at the injection site, and urinary retention were observed in the MA and TEA groups in the postoperative period. Conclusion. Epidural analgesia in thoracic surgery has a number of negative complications in the perioperative period, taking into account the lack of statistical difference (p>0.05) in groups according to oxygenation indicators, the use of a multimodal approach without the use of epidural support reduces the frequency of complications at all stages of complex treatment of patients.
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