术前竖脊肌平面阻滞对胸部手术患者术后应激和阿片类药物需求的影响  

Effect of preoperative erector spinae plane block on postoperative stress and opioid demand of patients undergoing thoracic surgery

作　　者：汪晓燕 潘琴 黄常君 李玉红 WANG Xiaoyan;PAN Qin;HUANG Changjun;LI Yuhong(Department of Anesthesiology,the First People's Hospital of Linping District,Hangzhou,Zhejiang 311100,China;不详)

机构地区：[1]杭州市临平区第一人民医院麻醉科,浙江杭州311100 [2]树人学院树兰国际医学院,树兰(杭州)医院麻醉科,浙江杭州310004

出　　处：《中华全科医学》2024年第8期1350-1353,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2024KY270)。

摘　　要：目的高剂量的阿片类镇痛药物可以控制胸部术后的剧烈疼痛,但容易引起恶心、呼吸抑制等副作用,本研究通过将术前竖脊肌平面阻滞(ESPB)应用于胸部手术,以探究其对患者术后应激和阿片类药物需求的影响。方法纳入2021年3月—2023年3月杭州市临平区第一人民医院收治的200例行肺癌根治术的患者,根据麻醉方式分为复合组(ESPB复合静脉全麻)和对照组(单纯全凭静脉麻醉),各100例。比较2组患者氧化应激指标、血清相关指标、疼痛情况和阿片类药物使用情况。结果2组肺癌患者术后24 h的丙二醛(MDA)水平均上升、超氧化物歧化酶(SOD)水平均下降,并且复合组MDA、SOD水平[(6.69±1.84)nmol/L、(37.30±6.42)U/mL]低于对照组[(9.03±1.35)nmol/L、(41.56±6.88)U/mL,P<0.05]。T1、T2及T3时,复合组白细胞介素6(IL-6)、皮质醇(Cor)及血管紧张素Ⅱ(Ang-Ⅱ)水平均低于对照组,IL-10水平高于对照组(P<0.05)。T2、T3和T4时,复合组静息、动态时VAS评分均低于对照组(P<0.05)。复合组术中瑞芬太尼用量[(554.8±97.2)μg]、24 h内镇痛泵舒芬太尼输注总量[(28.7±5.9)mL]及追加次数[(2.1±0.6)次]均低于对照组[(675.2±164.5)μg、(39.5±6.2)mL、(3.2±0.9)次,P<0.05]。结论ESPB复合静脉全麻应用于肺癌根治术,可改善应激与炎症反应,减轻患者术后疼痛程度,降低对阿片类药物的需求,是一种具有可行性、优越性的麻醉方式。Objective High-dose opioid analgesics can control severe pain after thoracic surgery,but can easily cause nausea,respiratory depression,and other side effects.In this study,erector spinae plane block(ESPB)was applied to thoracic surgery before operation to explore its influence on postoperative stress and opioid demand of patients.Methods From March 2021 to March 2023,200 patients with lung cancer who underwent elective radical resection of lung cancer in the First People's Hospital of Linping District,Hangzhou were divided into a control group(pure intravenous anesthesia)and a compound group(ESPB combined intravenous general anesthesia)according to anesthesia methods,with 100 patients in each group.The indexes of oxidative stress,serum-related indexes,pain,and opioid use were compared between the two groups.Results Malondialdehyde(MDA)levels increased and super oxide dismutase(SOD)levels decreased 24 h after operation in lung cancer patients in both groups.Moreover,MDA and SOD levels in the compound group[(6.69±1.84)nmol/L,(37.30±6.42)U/mL]were lower than those in the control group[(9.03±1.35)nmol/L,(41.56±6.88)U/mL,P<0.05].At T1,T2,and T3,the levels of IL-6,Cor,and Ang-Ⅱin the compound group were lower than those in the control group,and the levels of IL-10 were higher than those in the control group(P<0.05).At T2,T3,and T4,the scores of resting and dynamic VAS in the compound group were lower than those in the control group(P<0.05).The dosage of remifentanil in the compound group was(554.8±97.2)μg.The total amount of sufentanil infusion[(28.7±5.9)mL]and the number of supplementary infusion[(2.1±0.6)times]in 24 h were lower than those in the control group[(675.2±164.5)μg,(39.5±6.2)mL,(3.2±0.9)times,P<0.05].Conclusion The application of ESPB combined with intravenous general anesthesia in radical resection of lung cancer can improve stress and inflammatory reaction,and reduce postoperative pain and the demand for opioids.It is a feasible and superior anesthesia method.

关 键 词：竖脊肌平面阻滞 舒芬太尼 肺癌根治术 白细胞介素6 

分 类 号：R614.4[医药卫生—麻醉学] R734.2[医药卫生—外科学]