不同镇痛方案应用于胸腔镜下肺楔形切除术患者术后镇痛效果的评价  

Evaluation of the analgesic effect of different analgesic protocols in patients undergoing pulmonary wedge resection

作　　者：戚钰 郑文婷 王立伟[1] 周海[1] 吴从友[1] 周美艳[1] 王龙 徐海军[1] 刘松涛[1] Qi Yu;Zheng Wenting;Wang Liwei;Zhou Hai;Wu Congyou;Zhou Meiyan;Wang Long;Xu Haijun;Liu Songtao(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China;The Xuzhou Clinical College of Xuzhou Medical Uni‑versity,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院麻醉科,徐州221009 [2]徐州医科大学徐州临床学院,徐州221009

出　　处：《国际麻醉学与复苏杂志》2023年第10期1028-1032,共5页International Journal of Anesthesiology and Resuscitation

基　　金：徐州市科技创新重点研发计划(KC21251);江苏省麻醉重点实验室开放课题(XZSYSKF2021011)。

摘　　要：目的研究不同镇痛方案对胸腔镜下肺楔形切除术后的镇痛效果。方法选取120例拟行胸腔镜下肺楔形切除术的患者,按随机数字表法将患者分为4组(每组30例):A组[舒芬太尼患者自控静脉镇痛(patient‑controlled intravenous analge‑sia,PCIA)组]、B组(胸壁+肋间神经阻滞联合舒芬太尼PCIA组)、C组(艾司氯胺酮PCIA组)、D组(胸壁+肋间神经阻滞联合艾司氯胺酮PCIA组)。4组患者均实施全凭静脉麻醉。记录患者年龄、体重、ASA分级、手术时间、术中出血量、单肺通气时间及术后2、6、24、48、72 h的VAS疼痛评分。ELISA法检测并比较4组患者麻醉前和术后48 h血清疼痛介质[神经肽Y(neuropeptide Y,NPY)和P物质(substance P,SP)]水平,记录并比较不良反应发生率。结果4组患者年龄、体重、ASA分级、手术时间、术中出血量、单肺通气时间差异均无统计学意义(P>0.05)。各时刻组间比较,D组患者VAS疼痛评分均低于其余3组(P<0.05),B组患者VAS疼痛评分均低于A组、C组(P<0.05),C组患者VAS疼痛评分均低于A组(P<0.05)。4组患者术后48 h NPY和SP水平均高于麻醉前(P<0.05);4组患者麻醉前NPY和SP水平差异均无统计学意义(P>0.05);术后48 h D组患者NPY和SP水平均低于其余3组(P<0.05),B组患者均低于A组和C组(P<0.05),C组患者均低于A组(P<0.05)。4组患者不良反应发生率差异无统计学意义(P>0.05)。结论胸壁+肋间神经阻滞联合艾司氯胺酮PCIA对胸腔镜下肺楔形切除术后镇痛效果更好,更有效地抑制疼痛介质水平。Objective To investigate the analgesic effect of different analgesic protocols in patients underwent pulmonary wedge resection.Methods A total of 120 patients who underwent pulmonary wedge resection were enrolled.According to the random number table method,they were divided into four groups(n=30).Group A underwent patient-controlled intravenous analgesia(PCIA)with sufentanil,group B was subject to chest wall+intercostal nerve block plus PCIA with sufentanil,group C was given esketamine through PCIA,and group D was subject to chest wall+intercostal nerve block plus PCIA with esketamine.All the four groups were subject to intravenous anesthesia.Their age,weight,American Society of Anesthesiologists(ASA)grades,duration of surgery,perioperative blood loss,duration of single-lung ventilation,and Visual Analog Scale(VAS)scores were recorded at postoperative 2,6,24,48 h and 72 h.The levels of pain mediators,including serum neuropeptide Y(NPY)and substance P(SP)by ELISA testing,and the incidence of adverse re-actions were compared among the four groups before anesthesia and at postoperative 48 h.Results There were no statistical differenc-es in age,weight,ASA grades,duration of surgery,perioperative blood loss,duration of single-lung ventilation,and VAS scores among the 4 groups(P>0.05).For comparisons among groups at each time point,the VAS scores of group D were lower than those of the other three groups(P<0.05),the VAS scores of group B were lower than those of groups A and C(P<0.05),and the VAS scores of group C were lower than those of group A(P<0.05).At postoperative 48 h,patients in the four group showed higher NPY and SP than those before anesthesia(P<0.05).There was no statistical difference in NPY and SP among the four groups before anesthesia(P>0.05).At postoperative 48 h,patients in group D showed lower NPY and SP than those in the other three groups(P<0.05),while reduction in NYP and CP was seen in group B,compared with group A and group C(P<0.05),and group C showed lower NYP and CP than group A(P<0.05).No s

关 键 词：舒芬太尼 艾司氯胺酮 区域神经阻滞 患者自控静脉镇痛 肺叶切除术 疼痛介质 

分 类 号：R614[医药卫生—麻醉学]