术前超声下椎旁神经阻滞联合术毕前锯肌平面阻滞在肺癌患者电视辅助胸腔镜手术中的应用价值  

Application Value of Preoperative Ultrasound-guided Paravertebral Nerve Block Combined with End-of-Operation Serratus Anterior Plane Block in Video-assisted Thoracoscopic Surgery for Patients with Lung Cancer

作　　者：孙婧婧 路敏 杨静 SUN Jingjing;LU Min;YANG Jing(Department of Anesthesiology,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市人民医院麻醉科,河北沧州061000

出　　处：《临床误诊误治》2025年第9期45-52,共8页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2023年度医学科学研究课题(20232148);沧州市科学技术局项目(213106066)。

摘　　要：目的 探讨术前超声下椎旁神经阻滞(PVB)联合术毕前锯肌平面阻滞(SAPB)在肺癌患者电视辅助胸腔镜手术(VATS)中的应用效果。方法 选取2022年1月至2024年6月行VATS治疗的肺癌患者126例,采用随机数字表法分为对照组、观察组各63例。对照组给予术前超声下PVB,观察组给予术前超声下PVB联合术毕SAPB。比较2组入室时(T0)、拔管后30 min(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)血流动力学变化情况[心率、平均动脉压(MAP)]、疼痛介质[前列腺素E_(2)(PGE_(2))、P物质、β-内啡肽(β-EP)]、炎性因子[高迁移率族蛋白B1(HMGB1)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平,T1、T2、T3、T4静息时及活动时疼痛视觉模拟评分法(VAS)评分及康复相关指标、不良反应。结果 观察组T0~T4时间点心率、MAP波动幅度小于对照组(P<0.05);观察组术后2 h、4 h、8 h静息时及活动时疼痛VAS评分低于对照组(P<0.01);观察组T2、T4时间点PGE_(2)、P物质、β-EP及HMGB1、CRP、IL-6均低于对照组(P<0.01);观察组进食时间、首次排气时间、首次下床活动时间、住院时间均短于对照组(P<0.01);观察组首次按压静脉自控镇痛时间晚于对照组,术后48 h静脉自控镇痛有效按压次数及舒芬太尼使用量少于对照组(P<0.01);观察组不良反应发生率[7.94%(5/63)]与对照组[4.76%(3/63)]比较差异无统计学意义(P>0.05)。结论 术前超声下PVB联合术毕SAPB在肺癌VATS中应用效果显著,能稳定患者血流动力学,有效减轻术后疼痛,抑制疼痛介质及炎性因子的释放,促进患者术后快速康复,具有一定安全性。Objective To evaluate the application effect of preoperative ultrasound-guided paravertebral nerve block(PVB) combined with end-of-operation serratus anterior plane block(SAPB) in video-assisted thoracoscopic surgery(VATS) for patients with lung cancer.Methods A total of 126 patients with lung cancer who received VATS from January 2022 to June 2024 were selected and divided into control group(n=63) and observation group(n=63) by random number table method.The control group was given preoperative ultrasound-guided PVB,and the observation group was given preoperative ultrasound-guided PVB combined with end-of-operation SAPB.The two groups were compared at the time of entry(T0),at 30 min after extubation(T1),at 12 h after surgery(T2),24 h after surgery(T3) and 48 h after surgery(T4) with respect to hemodynamic changes [heart rate,mean arterial pressure(MAP)],pain mediators [prostaglandin E_2(PGE_2),Substance P(SP),β-endorphin(β-EP)],levels of inflammatory factors [high mobility group protein B1(HMGB1),C reactive protein(CRP),interleukin-6(IL-6)],resting and active visual analogue scale(VAS) pain scores at T1,T2,T3,and T4,rehabilitation related indicators,adverse reactions.Results The fluctuation of heart rate and MAP at T0-T4 in the observation group was smaller than that in the control group(P<0.05).The resting and active VAS pain scores at 2 h,4 h and 8 h in the observation group were lower than those in the control group(P<0.01).PGE_2,SP,β-EP,HMGB1,CRP and IL-6 in observation group were lower than those in control group at T2 and T4(P<0.01).The time of food intake,the first time of anal exhaust,the first time of off-bed activity,and the duration of hospitalization in the observation group were shorter than those in the control group(P<0.01).The first time of PCIA compression in the observation group was later than that in the control group,and the effective times of PCIA compression and Sufentanil consumption at 48 h after surgery were lower than those in the control group(P<0.01).There was no significant diff

关 键 词：肺肿瘤 电视辅助胸腔镜手术 麻醉 椎旁神经阻滞 前锯肌平面阻滞 术后镇痛 血流动力学 高迁移率族蛋白B1 

分 类 号：R734.2[医药卫生—肿瘤]