术前联合术毕胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后早期康复质量的影响  

Effects of preoperative combined with postoperative thoracic paravertebral nerve block on early postoperative rehabilitation quality of patients undergoing thoracoscopic lung cancer radical operation

作　　者：王若菡 康慷 李冰[1] 孟星 袁景丽 张加强 张伟[1] WANG Ruohan;KANG Kang;LI Bing;MENG Xing;YUAN Jingli;ZHANG Jiaqiang;ZHANG Wei(Department of Anesthesiology and Perioperative Medicine,People’s Hospital of Henan University,Zhengzhou,Henan 450003,China)

机构地区：[1]河南大学人民医院麻醉与围术期医学科,郑州450003

出　　处：《重庆医学》2022年第14期2383-2386,共4页Chongqing medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190607)。

摘　　要：目的评价不同时间点胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后早期康复质量的影响。方法择期行胸腔镜肺癌根治术患者150例,采用随机数字表法分为术前胸椎旁神经阻滞组(A组)、术毕胸椎旁神经阻滞组(B组)、术前联合术毕胸椎旁神经阻滞组(C组),每组50例。A组术前T4、6两点胸椎旁神经阻滞,B组术毕T4、6两点胸椎旁神经阻滞,C组术前、术毕T4、6两点胸椎旁神经阻滞。3组术毕时连接镇痛泵,术后随访,视觉模拟评分法(VAS)评分≥4分时给予阿片类药物补救镇痛。记录各组患者术后3 d内恶心、呕吐及补救镇痛的情况;采用中文版康复质量量表(QoR)评分评估术前和术后第1、2、3天康复质量。结果与A组比较,B、C组患者术后第1、2天QoR评分明显升高,术后3 d内恶心、呕吐及补救镇痛发生率明显下降(P<0.05)。与B组比较,C组患者术后第1、2天QoR评分明显升高,术后3 d内恶心、呕吐及补救镇痛发生率明显下降(P<0.05)。与A组比较,C组术后舒芬太尼用量降低(P<0.05)。结论术前联合术毕胸椎旁神经阻滞可明显改善胸腔镜肺癌根治术患者术后早期的康复质量。Objective To evaluate the effect of different time points of thoracic paravertebral nerve block on the quality of early postoperative rehabilitation in the patients undergoing thoracoscopic lung cancer radical surgery.Methods A total of 150 patients with elective thoracoscopic lung cancer radical operation were selected and divide into the preoperative paravertebral nerve block group(A group),postoperative paravertebral nerve block group(B group)and preoperative combined with postoperative paravertebral nerve block group(C group)by adopting the random number table method.Preoperative parathoracic nerve block in the group A was performed at two points of T4,6,postoperative parathoracic nerve block in the group B was performed at two points of T4,6,and preoperative combined with postoperative parathoracic nerve block at the two points of T4,6 in the group C was performed.The three groups were connected to the analgesic pump at the operation end.The postoperative follow up was performed.Opioid drug was given to remedy the analgesia when the VAS score≥4 points.Nausea,vomiting and remedial analgesia on postoperative 3 d were recorded;the Chinese version of the rehabilitation quality scale(QoR)score was used to evaluate the rehabilitation quality before surgery and on postoperative 1,2,3 d.Results Compared with the group A,the QoR scores on postoperative 1,2 d in the group B and C were significantly increased,and the incidence rates of nausea,vomiting and remedial analgesia were decreased significantly(P<0.05).Compared with the group B,the QoR scoreon postoperative 1,2 d in the group C was significantly increased and the incidence rates of nausea and remedial analgesia were significantly decreased(P<0.05).Compared with the group A,the postoperative sufentanil use amounts in the group C were decreased(P<0.05).Conclusion Preoperative combined with postoperative thoracic paravertebral nerve block can significantly improve the quality of early postoperative rehabilitation in the patients with thoracoscopic lung cancer ra

关 键 词：神经传导阻滞 胸腔镜 肺肿瘤 早期康复 

分 类 号：R614[医药卫生—麻醉学]