肋间神经阻滞对肺叶切除术后肺功能的影响

The effect of intraoperative intercostal nerve block on postoperative pulmonary function after lobectomy

目的探讨肋间神经阻滞对肺叶切除术后肺功能的影响。方法50例因肺部疾病择期行单肺叶切除的患者随机分成两组,A组为硬膜外术后镇痛(PCEA),B组为肋间神经阻滞联合PCEA;分别于术前、术后24h、术后48h用脉冲振荡肺功能测定仪(IOS)测定肺功能。结果A组与B组术前肺功能无显著性差异;术后24h两组与术前比较用力肺活量(FVC)、1秒用力呼气量(FEV1)降幅较大(P﹤0.05),呼吸总阻抗(Zrs)、共振频率(Fres)、35Hz时呼吸阻力(R35)、5Hz时呼吸电阻(X5)升高显著(P﹤0.05);术后48h两组FVC、FEV1、Zrs、Fres、R35、X5较术后24h有所恢复,但B组恢复较好(P﹤0.05)。结论术中肋间神经阻滞能改善患者早期肺功能。

Objective To evaluate the effect of intraoperative intercostal nerve block on postoperative pulmonary function after lobectomy. Methods Fifty patients underwent elective lobectomy, and were randomly divided into＇ group （A） PCEA and group （B） PCEA with intraoperative intercostal nerve block. Pulmonary function was measured before operation and at the 24th hour as well as the 48th hour after operation using impulse oscillometry（IOS）. Results Preoperative pulmonary tests showed that there was no remarkable difference between the two groups. Forced vital capacity（FVC） and forced expiratory volume in one second （FEV1） decreased significantly at the 24th hour compared with those of preoperative （P 〈 0.05）. Total pulmonary impedance （Zrs）, resonance frequency （Fres）, resistance to 35Hz （R35） and reactance to 5Hz （X5） improved significantly at 24th hour as compared with preoperative （P 〈 0.05）.Then FVC, FVE1, Zrs, Fres, R35 and X5 were improved at the 48th hour after operation, but the recovery of these parameter in group B was much more rapidly than that in group A （P 〈 0.05）. Conclusions The intraoperative intercostal nerve block can effectively improve pulmonary after in the early stage ater the operation.