胸椎旁神经阻滞用于胸腔镜下肺癌根治术的临床观察  

Clinical Efficacy of Thoracic Paravertebral Block Undergoing Thoracoscopic Radical Surgery for Lung Cancer

作　　者：张海华[1] 熊华平[1] 

机构地区：[1]中国人民解放军第180医院麻醉科,福建泉州362000

出　　处：《南昌大学学报（医学版）》2015年第5期51-54,58,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的评价胸椎旁神经阻滞(TPVB)用于胸腔镜下肺癌根治术的临床效果。方法将40例择期拟在全身麻醉下行胸腔镜下肺癌根治术的患者按随机数字表法分为2组:单纯全身麻醉组(G组)和TPVB复合全身麻醉组(GP组),每组20例。2组患者均选择静脉麻醉诱导气管插管,采用静吸复合麻醉维持。GP组于麻醉诱导前在神经刺激器引导下行T4—5椎旁神经阻滞;G组麻醉诱导前不给予任何处理。2组患者均于术毕使用舒芬太尼自控静脉镇痛,分别于术后2、24、48h时记录镇痛情况(VAS评分)、术后24及48h患者静脉自控(PCI)泵按压次数以及背景输注总量;观察2组患者术后不良反应(恶心、呕吐、嗜睡及呼吸抑制)的发生率。并分别于术前及术后24h时采集患者静脉血2mL,采用Elisa法检测血清血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)的水平。结果 GP组术后2、24h的VAS评分,术后24、48hPCI泵按压次数及背景输注总量均明显低于G组(均P<0.05);2组48h时VAS评分比较差异无统计学意义(P>0.05)。G组术后不良反应发生率为35.0%,GP组为30.0%,2组比较差异无统计学意义(P>0.05)。2组均未出现呼吸抑制。2组术前血清VEGF及MMP-9水平比较差异无统计学意义(P>0.05);术后24h均较术前明显升高,G组较GP组升高的更明显(均P<0.05)。结论与单纯全身麻醉比较,PTVB复合全身麻醉用于胸腔镜下肺癌根治术患者术后镇痛效果佳,并可抑制患者术后血清VEGF和MMP-9水平的升高。Objective To investigate the clinical efficacy of thoracic paravertebral block （TPVB）in patients undergoing thoracoscopic radical surgery for lung cancer.Methods Forty lung cancer patients scheduled for thoracoscopic radical surgery were randomly assigned to receive either general anesthesia alone（group G,n = 20）or in combination with TPVB（group GP,n =20）.All patients received inhalational agents for maintenance of anesthesia after intravenous anes-thesia induction and tracheal intubation.Patients in group GP underwent TPVB guided by nerve stimulator at T4-5 before anesthesia induction.Patients in group G received no treatment before anesthesia induction.After operation,patients received patient-controlled intravenous analgesia （PCIA）with sufentanil.The visual analogue scale（VAS）scores were recorded 2,24 and 48 hours after operation.The times of pressing patient-controlled intravenous（PCI）pump and the volume of background infusion were recorded 24 and 48 hours after operation.The incidence of postopera-tive adverse reactions （nausea,vomiting,lethargy and respiratory depression）was observed in both groups.Venous blood samples（2 mL）were collected before and 24 hours after operation,and serum levels of vascular endothelial growth factor（VEGF）and matrix metalloproteinase-9（MMP-9）were measured by ELISA.Results Compared with group G,VAS scores decreased 2 and 24 hours after operation and times of pressing PCI pump and volume of background infusion re-duced 24 and 48 hours after operation in group GP（P 〈0.05）.The difference in VAS scores was not significant between the two groups 48 hours after operation（P ＆gt;0.05）.Furthermore,the inci-dence of postoperative adverse reactions in group G（35.0%）was not significantly different from that in group GP（30.0%）（P 〉0.05）.No respiratory depression occurred in both groups.Before operation,no significant differences in serum levels of VEGF and MMP-9 were found between the two groups（P 〉0.05）.,However,the levels

关 键 词：胸椎旁神经阻滞 肺癌根治术 术后镇痛 血管内皮生长因子 基质金属蛋白酶-9 

分 类 号：R614[医药卫生—麻醉学]