超声引导下胸椎旁神经阻滞复合全麻对胸腔镜肺叶切除术患者术后痛觉过敏、炎症反应的影响  

Effect of Ultrasound-guided Thoracic Paravertebral Nerve Block Combined with General Anesthesia on Postoperative Hyperalgesia and Inflammation Response in Patients Undergoing Thoracoscopic Lobectomy

作　　者：杨洁[1] YANG Jie(Lianyungang City Ganyu District People's Hospital,Lianyungang 222100,China)

机构地区：[1]连云港市赣榆区人民医院,江苏连云港222100

出　　处：《中外医学研究》2023年第21期39-43,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:评价超声引导下胸椎旁神经阻滞复合全麻在胸腔镜肺叶切除术患者中的应用价值。方法:回顾性分析2021年1月—2022年6月在连云港市赣榆区人民医院实施胸腔镜下肺叶切除术的75例患者的临床资料,按照不同麻醉方法分对照组(n=35)与观察组(n=40)。对照组实施全麻,观察组于超声引导下实施胸椎旁神经阻滞复合全麻。比较两组术后痛觉过敏、镇痛效果、术后恢复情况、炎症反应与平均动脉压(MAP)、心率(HR)水平。结果:两组入室时(T_(0))时HR、MAP比较,差异无统计学意义(P>0.05);对照组诱导插管5 min(T_(1))、切皮后5 min(T_(2))、拔管前(T_(3))时HR、MAP较T_(0)均有所提升,差异有统计学意义(P<0.05);观察组T_(1)、T_(2)、T_(3)时HR、MAP均低于对照组,差异有统计学意义(P<0.05)。观察组术后1 h、2 h、6 h静息痛与活动痛评分均低于对照组,差异有统计学意义(P<0.05);但两组术后12 h、24 h静息痛、活动痛评分比较,差异无统计学意义(P>0.05)。观察组术后24 h镇痛有效按压次数少于对照组,首次镇痛按压时间晚于对照组,差异有统计学意义(P<0.05);但两组自主呼吸恢复时间、拔管时间及苏醒时间比较,差异无统计学意义(P>0.05)。观察组术后12 h、24 h痛觉过敏发生率低于对照组,差异有统计学意义(P<0.05)。术前1 d,两组炎症反应指标比较,差异无统计学意义(P>0.05);术后1 d,两组炎症反应指标较术前1 d均明显升高,但观察组低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下胸椎旁神经阻滞复合全麻能维持胸腔镜肺叶切除术患者血流动力学的稳定,提高术后镇痛效果。Objective:To evaluate the application value of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia in patients undergoing thoracoscopic lobectomy.Method:The clinical data of 75 patients who underwent thoracoscopic lobectomy in Lianyuangang City Ganyu District People's Hospital from January 2021 to June 2022 were retrospectively analyzed,they were divided into the control group(n=35)and the observation group(n=40)according to different anesthesia methods.The control group was given general anesthesia,and the observation group was given ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.Postoperative hyperalgesia,analgesic effect,postoperative recovery,inflammatory response,mean arterial pressure(MAP)and heart rate(HR)levels were compared between the two groups.Result:There were no statistically significant differences in HR and MAP between two groups at the time of entry(T_(0))(P>0.05);the HR and MAP of the control group at induction intubation 5 min(T_(1)),5 min after incision(T_(2))and before extubation(T_(3))were all improved compared with those at T_(0),and the differences were statistically significant(P<0.05);the HR and MAP of the observation group at T_(1),T_(2),and T_(3) were lower than those of the control group,and the differences were statistically significant(P<0.05).The scores of resting pain and active pain in the observation group at 1 h,2 h and 6 h after operation were lower than those in the control group,the differences were statistically significant(P<0.05);however,there were no significant difference in the scores of resting pain and active pain between two groups at 12 h and 24 h after operation(P>0.05).The effective pressing times of analgesia at 24 h after operation in the observation group was less than that in the control group,and the first analgesic compressions was later than that in the control group,the differences were statistically significant(P<0.05);however,there were no statistically significant difference in th

关 键 词：超声 胸椎旁神经阻滞 全麻 胸腔镜肺叶切除术 

分 类 号：R614.2[医药卫生—麻醉学]