不同术后镇痛方式对机器人辅助胸外科手术患者的镇痛效果比较

Effectiveness of different analgesic methods in patients underwent robot-assisted thoracic surgery:a comparative study

目的:比较胸段硬膜外镇痛(TEA)联合静脉自控镇痛(PCA)与肋间神经阻滞(INB)联合PCA在机器人辅助胸外科手术(RATS)患者的术后镇痛效果。方法:选取2020年1月—2023年9月于咸阳市第一人民医院行RATS 80例患者,采用随机数表法将其分为TEA+PCA组(40例,TEA联合PCA)和INB+PCA组(40例,INB联合PCA),比较两组镇痛效果、疼痛介质、认知功能、生活质量和不良反应。结果:与INB+PCA组比较,TEA+PCA组术后6 h、24 h、48 h、72 h静息时、咳嗽时数字分级评分法(NRS)评分更低(P<0.05)。与术前比较,两组术后72 h的β内啡肽(β-EP)降低(P<0.05),P物质(SP)、前列腺素E2(PGE2)升高(P<0.05),但与INB+PCA组比较,TEA+PCA组术后72 h的β-EP更高(P<0.05),SP、PGE2更低(P<0.05)。与术前比较,两组术后72 h的简易智能精神状态检查量表(MMSE)评分升高(P<0.05),恢复质量量表(QoR-15)评分无变化(P>0.05),但与INB+PCA组比较,TEA+PCA组术后72 h的MMSE评分更高(P<0.05),QoR-15评分无统计学意义(P>0.05)。与INB+PCA组的皮肤瘙痒率5.00%比较,TEA+PCA组的32.50%更高(P<0.05)。结论:与INB联合PCA相比较,TEA联合PCA应用于RATS患者,可有效减轻疼痛,改善认知功能,但皮肤瘙痒发生率较高。

Objective:To compare the analgesic effects of thoracic epidural analgesia(TEA)combined with patientcontrolled analgesia(PCA)and intercostal nerve block(INB)in patients underwent robot-assisted thoracic surgery(RATS).Methods:From January 2020 to September 2023,80 patients who underwent RATS in Xianyang First People’s Hospital were selected and divided into the TEA+PCA group(n=40,TEA combining with PCA)and the INB+PCA group(n=40,INB combining with PCA)using a random number table method.The analgesic effects,pain mediators,cognitive function,quality of life,and adverse reactions were compared between the two groups of patients.Results:Compared with the INB+PCA group,the TEA+PCA group had lower numeric rating scale(NRS)scores at rest and coughing 6 h,24 h,48 h,and 72 h after surgery(P<0.05).Compared with that before surgery,βEndorphin(β-EP)level decreased(P<0.05)72 h after surgery in both the two groups,and the levels of substance P(SP)and prostaglandin E2(PGE2)increased in the two groups(P<0.05).However,the TEA+PCA group had a higher level ofβ-EP at 72 h after surgery than the INB+PCA group(P<0.05)and lower levels of SP and PGE2(P<0.05).The mini mental state examination(MMSE)scores at 72 h after surgery were increased in the two groups(P<0.05),but there was no change in the quality of recovery scale(QoR-15)scores(P>0.05).However,the MMSE score at 72 h after surgery in the TEA+PCA group was higher than that in the INB+PCA group(P<0.05),no statistically significant difference in QoR-15 scores in the two groups were found(P>0.05).The skin itching rate of 32.50%in the INB+PCA group was higher than that of 5.00%in the TEA+PCA group(P<0.05).Conclusion:Compared with INB+PCA,TEA+PCA can effectively alleviate pain and improve cognitive function in patients underwent RATS,but it has a higher incidence rate of skin itching.