胸椎旁阻滞-丙泊酚复合麻醉在肺癌根治手术中的应用效果分析  

Effect analysis of thoracic paravertebral nerve block combined with propofol intravenous anesthesia in radical treatment of lung cancer

作　　者：罗松 王嘉祥 张威村 Luo Song;Wang Jiaxiang;Zhang Weicun(Department of Anesthesiology,Southern Theater General Hospital,Guangzhou 510000,China)

机构地区：[1]南部战区总医院麻醉科,广州510000

出　　处：《中国医师杂志》2023年第1期86-91,共6页Journal of Chinese Physician

摘　　要：目的探讨胸椎旁神经阻滞-丙泊酚静脉复合麻醉(PPA)对肺癌根治术患者血流动力学参数、炎症应激指标、术后镇痛及免疫指标的影响。方法选取2020年1月至2021年12月南部战区总医院收治的拟行肺癌根治术的116例肺癌患者,采用随机数字表法分为观察组和对照组,每组各58例,观察组采用PPA联合全身麻醉,对照组采用七氟醚吸入复合全麻;监测对比两组的血流动力学参数,术中及术后麻醉镇痛药物用量,术后患者的疼痛程度评分,手术前后血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、皮质醇(Cor)、去甲肾上腺素(NE)、血管细胞生长因子-C(VEGF-C)、转化生长因子-β1(TGF-β1)水平,T淋巴细胞,不良反应。结果观察组的术中瑞芬太尼用量、术后舒芬太尼用量均低于对照组(均P<0.05)。观察组和对照组T0~T3时刻的CO、SVRI、EVLWI比较,差异无统计学意义(均P>0.05);观察组T1~T2时的平均动脉压(MAP)高于对照组,T3时的MAP低于对照组(均P<0.05)。在术后2 h,观察组和对照组在静息状态下、咳嗽状态下的视觉模拟疼痛量表(VAS)评分差异均无统计学意义(均P>0.05);在术后4、12 h时观察组静息状态下VAS评分均低于对照组(均P<0.05),在术后4、12、24 h时观察组咳嗽状态下VAS评分均低于对照组(均P<0.05)。术前,观察组和对照组的血清IL-6、IL-10、Cor、NE、VEGF-C、TGF-β1水平比较,差异均无统计学意义(均P>0.05);术后24 h,观察组血清IL-6、NE、VEGF-C水平均低于对照组(均P<0.05)。术前,观察组和对照组的CD3+、CD4+、CD8+比较,差异均无统计学意义(均P>0.05);术后24 h,观察组CD3+高于对照组(P<0.05)。观察组的不良反应发生率(10.34%)低于对照组(24.14%,P<0.05)。结论肺癌根治术患者采用PPA实施麻醉有利于维持血流动力学参数稳定、减轻患者的炎症应激反应、减轻手术对患者免疫功能的影响,有利于减少手术中麻醉药物及术后镇痛药物的用�Objective To investigate the effects of thoracic paravertebral nerve block combined with propofol intravenous anesthesia(PPA)on hemodynamic parameters,inflammatory stress indexes,postoperative analgesia and immune indexes in patients with lung cancer undergoing radical surgery.Methods 116 patients with lung cancer admitted to the Southern Theater General Hospital from January 2020 to December 2021 were randomly divided into observation group and control group,with 58 patients in each group.The observation group received PPA combined with general anesthesia,and the control group received sevoflurane inhalation combined with general anesthesia;the hemodynamic parameters,the amount of anesthetic and analgesic drugs used during and after the operation,the pain score of the patients after the operation,the serum interleukin-6(IL-6),interleukin-10(IL-10),cortisol(Cor),norepinephrine(NE),vascular cell growth factor-C(VEGF-C),transforming growth factor-β1(TGF-β1)and T lymphocytes before and after the operation,adverse reactions of the two groups were monitored and compared.Results The intraoperative dosage of remifentanil and postoperative dosage of sufentanil in the observation group were lower than those in the control group(all P<0.05).There was no statistically significant difference in cardiac output(CO),systemic vascular resistance index(SVRI)and extravascular lung water index(EVLWI)between the observation group and the control group at T0 to T3(all P>0.05);The mean arterial pressure(MAP)at T1 to T2 in the observation group was higher than that in the control group,and the MAP at T3 was lower than that in the control group(all P<0.05).There was no significant difference between observation group and control group in Visual Analogue Scale(VAS)scores at resting state and coughing state 2 h after surgery(all P>0.05).The VAS scores in the observation group at resting state were lower than those in the control group at 4 h and 12 h after surgery(all P<0.05),and the VAS scores in the observation group at coughing state

关 键 词：肺肿瘤 神经传导阻滞 胸椎 丙泊酚 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]