持续肋间神经阻滞联合帕瑞昔布钠与自控静脉镇痛在单孔胸腔镜肺结节切除术后的应用  

Application of continuous intercostal nerve block combined with parecoxib sodium and patient⁃controlled intravenous analgesia pump in uniportal video⁃assisted thoracoscopic surgery for pulmonary nodule resection

作　　者：钟宏城 霍雯雯[2] 吕良湛 梁明柱 蔡开灿[1] ZHONG Hongcheng;HUO Wenwen;LÜLiangzhan;LIANG Mingzhu;CAI Kaican(Department of Thoracic Surgery,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong 510280,China;Department of Thoracic Surgery,Fifth Affiliated Hospital,Sun Yat-sen University,Zhuhai,Guangdong 519000,China;Department of Radiology,Fifth Affiliated Hospital,Sun Yat-sen University,Zhuhai,Guangdong 519000,China)

机构地区：[1]南方医科大学南方医院胸外科,广东广州510280 [2]中山大学附属第五医院胸外科,广东珠海519000 [3]中山大学附属第五医院放射科,广东珠海519000

出　　处：《热带医学杂志》2024年第8期1120-1124,1176,共6页Journal of Tropical Medicine

基　　金：广东省自然科学基金面上项目(2022A1515012509)。

摘　　要：目的对比持续肋间神经阻滞联合帕瑞昔布钠(ICNB+P)与自控静脉镇痛(PCIA)在单孔胸腔镜(U-VATS)肺结节切除术后的镇痛效果。方法回顾性分析2022年9-12月期间在中山大学附属第五医院行单孔胸腔镜肺结节切除术的病例数据共100例,根据纳入及排除条件,将其中93例符合要求的肺结节病例数据纳入本研究,使用ICNB+P进行镇痛的患者51例,列为ICNB+P组,使用PCIA镇痛的患者42例,为PCIA组。对两组患者术后视觉模拟评分(VAS)、膈肌移动度、术后不良反应、术后并发症进行比较。结果术后1、6、12、24、36、48 h,ICNB+P组静息状态的VAS评分均明显低于PCIA组,差异均有统计学意义(t=-5.782、-2.952、-4.033、-2.369、-2.149、-3.114,P均<0.05);ICNB+P组术后48 h内补救镇痛次数明显少于PCIA组,差异有统计学意义(t=-4.185,P<0.05)。ICNB+P组术后24 h膈肌移动度明显大于PCIA组,差异有统计学意义(t=2.345,P<0.05),ICNB+P组术后24 h膈肌移动度变化差值与变化率均明显小于PCIA组,差异均有统计学意义(t=-3.097、-3.550,P均<0.05)。ICNB+P组中未发现恶心、呕吐、头晕、过敏,其中头晕的发生率明显低于PCIA组,差异有统计学意义(χ^(2)=4.290,P<0.05);ICNB+P组肺炎发生率低于PCIA组,差异有统计学意义(χ^(2)=4.019,P<0.05)。结论ICNB+P应用于U-VATS术后比PCIA具有更良好的镇痛效果,能减少补救镇痛次数,副作用和并发症的发生率更低,更有利于恢复呼吸运动,提高术后恢复质量,具有良好的临床推广价值。Objective To compare the analgesic effects of continuous intercostal nerve block combined with parecoxib sodium(ICNB+P)versus patient⁃controlled intravenous analgesia pump(PCIA)in patients undergoing uniportal video⁃assisted thoracoscopic surgery(U⁃VATS)for pulmonary nodule resection.Methods The data of 100 cases of single⁃hole thoracoscopic pulmonary nodule resection in the Fifth Affiliated Hospital of Sun Yat⁃sen University from September to December,2022 were retrospectively analyzed.According to the inclusion and exclusion conditions,93 cases of qualified pulmonary nodule data were included in this study.A total of 51 patients with ICNB+P analgesia were categorized as the ICNB+P group,and 42 patients with PCIA analgesia were categorized as the PCIA group.The postoperative visual analog scale(VAS)pain scores,diaphragmatic mobility,postoperative adverse reactions,and complications were compared between the two groups.Results At 1,6,12,24,36,48 h after operation,the resting VAS scores of ICNB+P group were ignificantly lower than those of PCIA group(t=-5.782,-2.952,-4.033,-2.369,-2.149,-3.114;all P<0.05).The number of analgesic remedies in ICNB+P group within 48 hours after operation was significantly less than that in PCIA group(t=-4.185,P<0.05).The diaphragmatic mobility in ICNB+P group was significantly higher than that in PCIA group 24 hours after operation(t=2.345,P<0.05).The difference and change rate of diaphragmatic mobility in ICNB+P group 24 hours after operation were significantly lower than that in PCIA group(t=-3.097,-3.550;all P<0.05).No nausea,vomiting,dizziness and allergy were found in ICNB+P group,and the incidence of dizziness was significantly lower than that in PCIA group(χ^(2)=4.290,P<0.05).The incidence of pneumonia in ICNB+P group was lower than that in PCIA group with statistical significance(χ^(2)=4.019,P<0.05).Conclusions ICNB+P had better analgesic effect than PCIA after U⁃VATS surgery,could reduce the number of analgesic rescue times,had lower incidence of side effects a

关 键 词：持续肋间神经阻滞 帕瑞昔布钠 自控静脉镇痛 单孔胸腔镜术 肺结节切除术 

分 类 号：R655.3[医药卫生—外科学]