术前罗哌卡因竖脊肌平面阻滞联合全身麻醉对老年患者肺癌根治术后谵妄及快速康复的影响  

Effect of ropivacaine erector spinae plane block combined with general anesthesia on postoperative delirium and rapid postoperative recovery in elderly patients undergoing thoracoscopic radical lung cancer treatment

作　　者：严志勇 汪涛 吴浩 许旭 樊倩楠 戴体俊 YAN Zhiyong;WANG Tao;WU Hao;XU Xu;FAN Qiannan;DAI Tijun(Anesthesiology College of Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Shuyang Hospital Affiliated to Xuzhou Medical University,Suqian,Jiangsu 223600,China;Suqian First People’s Hospital Affiliated to Nanjing Medical University,Suqian,Jiangsu 223800,China;Department of Anesthesiology and Pharmacology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China)

机构地区：[1]徐州医科大学麻醉学院,221004 [2]徐州医科大学附属沭阳医院,223600 [3]南京医科大学附属宿迁第一人民医院,223800 [4]徐州医科大学麻醉药理学教研室,221004

出　　处：《重庆医学》2023年第12期1795-1799,共5页Chongqing medicine

基　　金：国家自然科学基金项目(30872432);徐州医科大学江苏省重点实验室开放课题资助项目(XZSYSKF2020040)。

摘　　要：目的探讨术前罗哌卡因竖脊肌平面阻滞复合全身麻醉对老年患者胸腔镜下肺癌根治术后谵妄及术后快速康复的影响。方法选取行胸腔镜下肺癌根治术的老年患者98例为研究对象,根据随机数字表法将患者分为全身麻醉组(GA组)和全身麻醉复合竖脊肌平面阻滞组(GA+ESP组),每组49例。对两组患者在不同时间点的术后谵妄、疼痛评分、不良反应及术后恢复情况等进行比较。结果GA组和GA+ESP组患者在术后6 h、术后24 h及术后48 h等时间点的术后谵妄发生率差异有统计学意义(P<0.05)。GA组和GA+ESP组患者在术后4 h、术后8 h、术后12 h、术后24 h及术后48 h等时间点,静息痛与咳嗽痛评分的差异均有统计学意义(P<0.05)。GA组和GA+ESP组患者在苏醒延迟发生率、苏醒期躁动发生率、皮肤瘙痒发生率、恶心呕吐发生率及镇痛泵按压次数等方面的差异均有统计学意义(P<0.05)。GA组和GA+ESP组患者术后第1天晚上睡眠质量、胸管拔除时间、尿管拔除时间、术后首次下床活动时间及住院时间等的差异均有统计学意义(P<0.05)。结论术前竖脊肌平面阻滞联合全身麻醉的胸腔镜下肺癌根治老年患者的术后镇痛效果更好,术后谵妄和不良反应的发生率更低,利于患者术后的快速康复。Objective To determine the effect of ropivacaine erector spinae plane block combined with general anesthesia on postoperative delirium and rapid postoperative recovery in elderly patients undergoing thoracoscopic radical lung cancer treatment.Methods A total of 98 elderly patients undergoing thoracoscopic radical resection of lung cancer were selected as the study objects.According to the random number table method,all patients were randomly divided into the general anesthesia group(the GA group)and the general anesthesia combined erector spinae plane block group(the GA+ESP group),with 49 cases in each group.The GA group received conventional general anesthesia,the GA+ESP group received general anesthesia combined with erector spinae plane block.Postoperative delirium,pain scores,adverse reactions and postoperative recovery were compared between the two groups at different time points.Results There were statistically significant differences in postoperative delirium incidence between the GA group and the GA+ESP group at 6,24 and 48h after surgery(P<0.05).In the GA group and the GA+ESP group,there were statistically significant differences in resting pain scores and cough pain scores at 4 h,8 h,12 h,24 h and 48 h after surgery and other time points(P<0.05).There were statistically significant differences between the GA group and the GA+ESP group in the incidence of delayed awakening,agitation,skin pruritus,nausea and vomiting,as well as the times of analgesic pump pressing(P<0.05).There were significant differences between the GA group and the GA+ESP group in sleep qualityon the first day after operation,chest tube extraction time,urinary tube extraction time,first out of bed activity time and hospital stay(P<0.05).Conclusion Compared with general anesthesia alone,the postoperative analgesia effect of elderly patients undergoing thoracoscopic radical resection of lung cancer before operation with erector spinae plane block combined with general anesthesia is better,the incidence of postoperative delirium and adver

关 键 词：竖脊肌平面阻滞 胸腔镜下肺癌根治术 老年患者 术后谵妄 快速康复 不良反应 

分 类 号：R614[医药卫生—麻醉学]