中文摘要：

目的探讨超声引导胸椎旁神经阻滞在胸腔镜下胸交感神经切断术应用的安全性及有效性。方法 120例中度以上多汗症患者,采用随机数字法将患者随机分为超声引导胸椎旁神经阻滞组（A组）及气管内插管全麻组（B组）,每组各60例。两组病人入手术室行常规监测并桡动脉穿刺置管测压。A组胸椎旁神经阻滞后仅鼻导管吸氧;B组行常规气管内插管全麻下完成手术。两组分别于术前、术后5 min行动脉血气分析并记录两组临床效果及并发症。结果两组均顺利完成手术,A组无1例转为气管内插管全身麻醉。A组和B组的麻醉准备时间（15.46±8.32 min vs 35.65±11.12 min）,术后清醒出手术室时间（6.26±2.09 min vs46.32±15.76 min）,住院费用（6355.54±426.00元vs 8932.25±725.98元）差异有统计学意义（P〈0.05）。A组术后咽喉部不适等（0%vs 100%）,术后监护时间（2 h vs 12 h）,术后进食时间（2 h vs 6 h）均优于气管内插管全身麻醉组。术前两组患者血气分析各指标无差异;术后两组患者血PH、PaCO_2、PaO_2无明显变化;同术前相比,两组患者血PaCO_2升高及PH下降,两组间差异有统计学意义,PaO_2无明显变化。结论超声引导胸椎旁神经阻滞应用于胸腔镜下胸交感神经节切断术安全,有效,并发症少,促进患者康复。

英文摘要：

Objective To explore the anesthetic effect and safety of ultrasound-guided thoracic paravertebral blockade in videoassisted thoracoscopic sympathectomy for treatment of palmar hyperhidrosis. Methods A total of 120 patients undergoing video-assisted thoracoscopic sympathectomy for moderate or severe hyperhidrosis were randomized to receive ultrasoundguided thoracic paravertebral blockade（group A, n=60） or general anesthesia with tracheal intubation（group B, n=60）. In both groups routine monitoring and radial artery catheterization were used. The patients in group A were given oxygen inhalation via a nasal tube after thoracic paravertebral blockade, and those in group B had intratracheal intubation. Blood gas analyses were conducted 5 min before and 5 min after the operation and the clinical outcomes and complications were recorded in each group. Results All the patients completed the operations safely and none of the patients with thoracic paravertebral blockade required conversion to general anesthesia. Significant differences were recorded between groups A and B in anesthetic preparation time（6.26 ± 2.09 vs 46.32 ± 15.76 min）, awakening time（6.26 ± 2.09 vs 46.32 ± 15.76 min）, and mean hospitalization expense（6355.54 ± 426.00 vs 8932.25 ± 725.98 RMB Yuan）. Compared with those in group B, the patients in group A showed a significantly lower rate of postoperative throat discomfort（0% vs 100%）, a shorter monitoring time（2 h vs 12 h）, and faster recovery time for food intake（2 h vs 6 h）. The parameters of artery blood gas analysis both before and after the operation were similar between the two groups, but the postoperative variations differed significantly between the two groups in p H value and PaCO_2 but not in PaO_2. Conclusion Ultrasound-guided thoracic paravertebral blockade is safe and effective in videoassisted thoracoscopic sympathectomy for palmar hyperhidrosis and is associated with less complications and better postoperative recovery.