罗哌卡因、倍他米松联合亚甲蓝经胸膜外肋间神经阻滞治疗肺癌开胸术后慢性切口痛的疗效观察  

Effect of ropivacaine and betamethasone combined with methylene blue transpleural intercostal nerve block on incisional chronic pain after thoracotomy for lung cancer

作　　者：李美睿 张广建 Li Meirui;Zhang Guangjian(Department of Painology,Affiliated Hospital of Yanbian University,Yanji City,Jilin Province 133000,China)

机构地区：[1]延边大学附属医院疼痛科,吉林省延吉市133000

出　　处：《中华疼痛学杂志》2023年第1期93-98,共6页Chinese Journal Of Painology

基　　金：吉林省科技发展计划基金(20200201557JC)。

摘　　要：目的观察罗哌卡因、倍他米松联合亚甲蓝经胸膜外肋间神经阻滞治疗肺癌开胸术后慢性切口痛的有效性和安全性。方法收集2017年5月至2019年2月延边大学附属医院疼痛科收治的肺癌开胸术后疼痛患者60例, 病程9~21个月, 性别不限, 年龄52~79岁。采用随机数字表法分为两组, 每组30例:罗哌卡因+倍他米松组(Rop组)采用1%罗哌卡因7.5 ml+倍他米松2 mg, 生理盐水配制成15 ml;罗哌卡因、倍他米松联合亚甲蓝组(Rop+MB组)采用1%罗哌卡因7.5 ml+倍他米松2 mg+亚甲蓝20 mg, 生理盐水配制成15 ml。两组患者均在超声引导下行胸膜外肋间神经阻滞, 并记录治疗前和治疗后1、4、8、12周时的VAS评分及生活质量评分、阿片类药物日使用剂量;观察治疗后8、12周时的疗效和不良反应。结果两组治疗后1、4、8、12周时VAS评分均较治疗前降低, Rop组依次为[(4.2±1.7)、(4.6±0.8)、(5.7±1.1)、(5.7±1.1)比(7.6±0.8)]分;Rop+MB组依次为[(4.5±1.3)、(4.2±0.7)、(3.6±0.6)、(2.9±1.0)比(7.5±1.0)]分, 差异均有统计学意义(P均<0.05)。与治疗前比较, 两组治疗后VAS评分0~3分例数均升高(P<0.05), 治疗后第8、12周0~3分患者例数Rop组为12例和8例, Rop+MB组为24例和22例, 两组间比较差异均有统计学意义(P均<0.05)。两组治疗后1、4、8、12周时生活质量综合评分较治疗前升高, Rop组依次为[(49.30±1.60)、(83.50±2.70)、(57.20±3.10)、(47.20±2.10)比(26.30±1.50)]分, Rop+MB组依次为[(48.60±1.54)、(82.20±2.60)、(88.50±3.61)、(94.20±3.31)比(25.60±1.90)]分, 差异均有统计学意义(P均<0.05)。治疗后8、12周时总有效率及优良率, Rop+MB组显著高于Rop组, 差异均有统计学意义(P<0.05);治疗后8、12周时盐酸羟考酮缓释片日剂量明显减少(P<0.05)。两组患者均未见气胸、胸闷或呼吸困难等并发症。结论罗哌卡因、倍他米松联合亚甲蓝可提高罗哌卡因和倍他米松经胸膜外肋间神经阻滞Objective To observe the efficacy and safety of transpleural surface intercostal nerve block with ropivacaine and betamethasone combined with methylene blue for incisional pain after thoracotomy in patients with lung cancer.Methods Sixty patients with incisional chronic pain after thoracotomy for lung cancer in the Pain Department,Affiliated Hospital of Yanbian University from May 2017 to February 2019 were collected and divided into two groups(n=30),with diseased course 9-21 months,both sexes,age 52-79 years old.Patients were treated by 1%ropivacaine 7.5 ml+betamidone 2 mg,diluted to 15 ml with normal saline in Rop group;by 1%ropivacaine 7.5 ml+betamidone 2 mg+methylene blue 2 mg,diluted to 15 ml by normal saline in Rop+MB group.VAS,quality of life scores,opioid dosage were recorded before and at 1 week,4 weeks,8 weeks and 12 weeks after the treatment.Efficacy and adverse reactions were observed at 8 weeks and 12 weeks after treatment.Results The VAS decreased at 1 week,4 weeks,8 weeks and 12 weeks after the treatment in both groups compared with that before the treatment,[(4.2±1.7),(4.6±0.8),(5.7±1.1),(5.7±1.1)vs.(7.6±0.8)]respectively in the Rop group,[(4.5±1.3),(4.2±0.7),(3.6±0.6),(2.9±1.0)vs.(7.5±1.0)]respectively in the Rop+MB group(all P<0.05).Compared with pretreatment,the number of patients of VAS 0-3 were increased in both groups after the treatment,while the cases were 12 and 8 at 8 weeks and 12 weeks in the Rop group compared with 24 and 22 in the Rop+MB group(all P<0.05).The GQOLI-74 scores increased in the two groups at 1 week,4 weeks,8 weeks and 12 weeks after the treatment,[(49.30±1.60),(83.50±2.70),(57.20±3.10),(47.20±2.10)vs.(26.30±1.50)]in the Rop group respectively,[(48.60±1.54),(82.20±2.60),(88.50±3.61),(94.20±3.31)vs.(25.60±1.90)]respectively in the Rop+MB group(all P<0.05).Compared with Rop group,the dosage of oxycodone hydrochloride tablets were significantly decreased at 8 weeks and 12 weeks after the treatment(P<0.05).The effective ratio and excellent and good ratio w

关 键 词：亚甲蓝 肺肿瘤 手术 胸外科 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]