The Effect Of Intercostal Nerve Block Analgesia Guided By Sonography On BNP And Cardiac Function After Video-assisted Thoracoscopic Surgery

Object: To observe the effect of intercostal nerve block analgesia guided by sonography on BNP and cardiac function after video-assisted thoracoscopic surgery.Methods: Included in the november 2015 to june 2016 the institute of cardiothoracic surgery 50 patients who underwent video-assisted thoracoscopic surgery（VAT_S）,ASA grade I II and cardiac function is good LVEF>50%.The selected patients were divided into two groups according to the random number table,group GN: general anesthesia combined with ultrasound guide intercostal nerve block（INB）（GN group,n =25）,induction of the INB analgesia before anesthesia;group G: general anesthesia group（group G,n = 25）do not any preoperative analgesia.T_aked patients’ venous blood before the operation and the seventh,third day in postoperative for BNP measurement value;preoperative and the seventh day in postoperative was measured by echocardiography,noted the specific numerical documented LVEF and LVEDD.After the operation,recorded the VAS score at 2h（T_a）,4h（T_b）,6h（T_c）,8h（T_d）and 24h（T_e）,comparison of two groups of postoperative 24 h,48h patients controlled intravenous analgesia（PCIA）of the number of times and adverse reactions after surgery,respectively in the following time points: in the operating room（T_I）,insert the endotracheal tube（T₂）,skin incision after 5min（T₃）,single lung ventilation after 5 min（T₄）,operation at the end of the surgery（T₅）records of two groups of patients with MAP and HR.Compared the dosage of propofol and remifentanil during operation between the two groups.Compared the total time the two groups of patients took in CCU,and counted postoperative CCU costs and total hospitalization expenses.Results: In the third day and seventh day after operation,the value of BNP in group GN and group G were higher than that of BNP before operation（P<0.05）.The value of BNP in group GN was lower than that in group G（P<0.05）at the third and seventh day after operation.The value of LVEDD after operation in group GN and group G was more higher than that before operation,the value of LVEDD in group GN was more higher than group G after operation（P<0.05）.The value of LVEF in group G was lower than group GN in the seventh day after operation,and the value of LVEF in group GN,G after operation were lower than that before operation（P<0.05）.With the cardiac function decreasing the BNP will increase.BNP and LVEDD have positive correlation,BNP with the LVEF has negative correlation.T_he VAS score in group GN were less than that in group G at T_a and T_b（P<0.05）.Compared with T₂,the MAP in the two groups more higher than at T₁（P<0.05）.T_he MAP in group G was higher than group GN at T₃,T₄ and T₅（P<0.05）.T_he dosage of propofol and remifentanil in group GN were less than group G（P<0.05）.Additionally,the costs of group GN were less than group G in intraoperative anesthesia and ICU costs（P<0.05）.Conclusion: T_horacoscopic surgery can affect the patient’s cardiac function,and with postoperative cardiac function reducing the BNP will increase.Preemptive analgesia can relatively improve cardiac function after operation;preemptive analgesia not only reduce the drug dosage in operation and make the analgesic effect better,shorten the hospitalization days,reduce the costs of hospitalization.