不同区域神经阻滞对胸腔镜肺癌根治术患者阿片类药物用量和应激反应的影响  

Effects of nerve block in different areas on opiate dosage and stress response in patients undergoing thoracoscopic radical resection of lung cancer

作　　者：黄益波 王梅芳[1] 贺腾 濮健峰[1] HUANG Yibo;WANG Meifang;HE Teng;PU Jianfeng(Department of Anesthesiology,Changshu Second People s Hospital,Suzhou,Jiangsu 215500,China)

机构地区：[1]常熟市第二人民医院麻醉科,江苏苏州215500

出　　处：《中国临床研究》2024年第1期61-65,共5页Chinese Journal of Clinical Research

基　　金：常熟市科研计划项目(cswsq201903)。

摘　　要：目的探讨胸腔镜肺癌根治术患者进行超声引导下前锯肌平面阻滞(SAPB)与胸椎旁神经阻滞(TPVB)对阿片类药物用量和应激反应的影响。方法选取2019年6月至2022年1月于常熟市第二人民医院择期接受胸腔镜肺癌根治术的患者130例,根据随机数字表法分为SAPB组65例和TPVB组65例。麻醉诱导前,SAPB组进行超声引导下SAPB,TPVB组进行超声引导下TPVB,术后均连接镇痛泵给予静脉自控镇痛。将术前、关闭胸腔时、术后2 h、6 h和24 h等时间点分别设为T_(1)、T_(2)、T_(3)、T_(4)和T_(5),记录两组术中出血量、术中补液量、手术时间、术中舒芬太尼及丙泊酚用量和术后T_(3)、T_(4)和T_(5)舒芬太尼累积使用量;分别于T_(3)、T_(4)和T_(5)采用Prince-Henry评分评估两组疼痛变化,酶联免疫法检测前列腺素E_(2)(PGE_(2))、去甲肾上腺素(NE)和皮质醇(Cor)水平,血气分析仪检测动脉血氧分压,计算氧合指数(OI);记录两组术后不良事件发生情况。结果T_(3)~T_(5)时间点,SAPB组PGE_(2)、NE和Cor水平显著低于TPVB组(P<0.05)。两组T_(2)~T_(4)时的OI较T_(5)时明显降低,T_(2)时的OI较T_(2)、T_(3)、T_(4)时明显升高,且SAPB组T_(2)~T_(4)时的OI显著高于TPVB组(P<0.05)。SAPB组在T_(3)~T_(5)累积消耗的舒芬太尼用量稍低于TPVB组,但差异无统计学意义(P>0.05)。SAPB组恶心呕吐(6.15%vs 18.46%,χ^(2)=4.561,P=0.033)、肺不张(3.08%vs 12.31%,χ^(2)=3.900,P=0.048)和低血压(7.69%vs 20.00%,χ^(2)=4.127,P=0.042)发生率均低于TPVB组。结论在超声引导下,与TPVB比较,SAPB可缓解胸腔镜肺癌根治术患者应激反应,促进肺氧合功能恢复,减少术后不良事件。但能否显著降低阿片类药物用量,有待进一步探讨。Objective To explore the effects of ultrasound-guided serratus anterior plane block(SAPB)and thoracic paravertebral block(TPVB)on opiate dosage and stress response in patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 130 patients undergoing elective thoracoscopic radical resection of lung cancer in Changshu Second People s Hospital between June 2019 and January 2022 were enrolled.According to the random number table method,they were divided into SAPB group(65 cases,ultrasound-guided SAPB before anesthesia induction)and TPVB group(65 cases,ultrasound-guided TPVB before anesthesia induction).After surgery,all underwent patient-controlled intravenous analgesia with analgesia pumps.The timepoints including preoperative,thoracic closure,and postoperative 2,6,and 24 hours were set as T_(1),T_(2),T_(3),T_(4) and T_(5),respectively,and the intraoperative blood loss and fluid supplement,operation time,intraoperative dosages of sufentanil and propofol,and postoperative cumulative dosages of sufentanil at T_(3),T_(4) and T_(5) in the two groups were recorded.At T_(3),T_(4) and T_(5),pain changes were evaluated by Prince-Henry scores.The levels of prostaglandins E_(2)(PGE_(2)),norepinephrine(NE)and cortisol(Cor)were detected by enzyme-linked immunosorbent assay.The partial pressure of arterial oxygen was detected by a blood gas analyzer,and oxygenation index(OI)was calculated.The occurrence of postoperative adverse events(PAEs)in the two groups was recorded.Results From T_(3) to T_(5),levels of PGE_(2),NE,and Cor in SAPB group were significantly lower than those in TPVB group(P<0.05).OI at T_(2) to T_(4) was significantly lower than that at T_(1),while OI at T_(5) was significantly higher than that at T_(2),T_(3),and T_(4) in both groups(P<0.05).From T_(2) to T_(4),OI in SAPB group was significantly higher than that in TPVB group(P<0.05).Compared with TPVB group,the cumulative consumption of sufentanil in SAPB group slightly decreased from T_(3) to T_(5),but the differences were not statis

关 键 词：超声引导 前锯肌平面阻滞 胸椎旁神经阻滞 胸腔镜肺癌根治术 阿片类药物 应激反应 

分 类 号：R614.4[医药卫生—麻醉学]