胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果  

Application effect of thoracic paravertebral nerve block combined with general anesthesia in patients undergoing thoracoscopic radical resection of lung cancer

作　　者：张新科[1] 司海超[1] 司小萌[1] 杨建彬[1] 张爽 秦洪猛 金哲[2] ZHANG Xinke;SI Haichao;SI Xiaomeng;YANG Jianbin;ZHANG Shuang;QIN Hongmeng;JIN Zhe(First Department of Surgery,Nanyang Central Hospital,Nanyang 473000,He’nan,China;Department of Thoracic Surgery,Nanyang Central Hospital,Nanyang 473000,He’nan,China)

机构地区：[1]南阳市中心医院手术一部,河南南阳4730000 [2]南阳市中心医院胸外科,河南南阳4730000

出　　处：《癌症进展》2024年第13期1489-1492,共4页Oncology Progress

摘　　要：目的探讨胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果。方法根据麻醉方法的不同将65例胸腔镜肺癌根治术患者分为全麻组(n=31,单纯全身麻醉)和联合组(n=34,胸椎旁神经阻滞联合全身麻醉)。比较两组患者的疼痛情况[视觉模拟评分法(VAS)评分、术后24 h镇痛泵按压次数]、瑞芬太尼用量、苏醒进程指标、应激反应指标[去甲肾上腺素(NE)、超氧化物歧化酶(SOD)、丙二醛(MDA)]及术后并发症发生情况。结果术后2、6、12、24 h,联合组患者VAS评分均明显低于全麻组(P﹤0.01);联合组患者术后24 h镇痛泵按压次数明显少于全麻组(P﹤0.01)。联合组患者瑞芬太尼用量明显少于全麻组,苏醒时间和自主呼吸恢复时间均明显短于全麻组,差异均有统计学意义(P﹤0.01)。术后,两组患者NE、MDA水平均高于本组术前,SOD水平均低于本组术前,联合组患者NE、MDA水平均低于全麻组,SOD水平高于全麻组,差异均有统计学意义(P﹤0.05)。联合组患者术后并发症总发生率低于全麻组(P﹤0.05)。结论胸椎旁神经阻滞联合全身麻醉应用于胸腔镜肺癌根治术患者,不仅能够减轻疼痛程度和应激反应程度,还能够减少阿片类药物用量,降低并发症发生率。Objective To explore the application effect of thoracic paravertebral nerve block combined with general anesthesia in patients undergoing thoracoscopic radical resection of lung cancer.Method A total of 65 patients with thoracoscopic radical resection for lung cancer were divided into general anesthesia group(n=31,general anesthesia alone)and combination group(n=34,thoracic paravertebral nerve block combined with general anesthesia)according to different anesthesia methods.The pain status[visual analogue scale(VAS)score,number of analgesic pump compressions 24 h after surgery],remifentanil dosage,awakening process indexes,stress response indexes[norepinephrine(NE),superoxide dismutase(SOD),malondialdehyde(MDA)]and postoperative complications were compared between the two groups.Result At 2,6,12 and 24 h after surgery,the VAS scores in combination group were significantly lower than those in general anesthesia group(P<0.01).The number of analgesic pump compressions 24 h after surgery in combination group was significantly lower than that in general anesthesia group(P<0.01).The dosage of remifentanil in combination group was significantly lower than that in general anesthesia group,the wake-up time and spontaneous respiration recovery time were significantly shorter than those in general anesthesia group,and the differences were statistically significant(P<0.01).After surgery,the levels of NE and MDA in both groups were higher than those before surgery,and the levels of SOD were lower than those before surgery,the levels of NE and MDA in combination group were lower than those in general anesthesia group,and the level of SOD was higher than that in general anesthesia group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in combination group was lower than that in general anesthesia group(P<0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia in patients undergoing thoracoscopic radical resection of lung cancer can not only

关 键 词：胸腔镜肺癌根治术 胸椎旁神经阻滞麻醉 全身麻醉 应用效果 

分 类 号：R734.2[医药卫生—肿瘤]