PCIA联合PVB对肺癌开胸手术镇痛情况、舒芬太尼使用总量及安全性分析

Analgesic effect,effect on sufentanil amount and safety of the combination of PCIA and PVB in thoracotomy for lung cancer

目的探讨静脉麻醉自控镇痛(PCIA)联合超声引导下椎旁神经阻滞(PVB)在肺癌开胸患者术后镇痛中的效果。方法选取行全身麻醉下开胸肺癌根治术的60例患者为研究对象,采用随机数字表法将患者分为联合组(术后采用PCIA联合PVB)和对照组(仅采取PCIA),每组各30例,对比两组在术后不同时间点的疼痛程度、术后舒芬太尼用量、患者血流动力学指标、血清炎性因子及不良反应发生情况。结果术后4、8、16、24 h,联合组患者的VAS评分低于同时间点的对照组(P﹤0.05);术后即刻及术后4、8、16、24 h,联合组和对照组的SBP、DBP、HR水平比较,差异均无统计学意义(P﹥0.05);术后12、24 h,联合组患者的血清TNF-α、IL-6、IL-10水平低于对照组(P﹤0.05);联合组患者术后24 h的舒芬太尼用量及不良反应发生率均低于对照组(P﹤0.05)。结论PCIA联合PVB在肺癌开胸患者术后镇痛中的效果优于单用PCIA,并且具有较高的安全性。

Objective To investigate the postoperative analgesic effect of patient-controlled intravenous analgesia（PCIA） in combination with ultrasound guided paravertebral block（PVB） in thoracotomy for lung cancer. Method 60 patients who had undergone radical resection for lung cancer under general anesthesia were enrolled and divided into combination group（given postoperative analgesia treatment with PCIA in combination with PVB） and control group（given PCIA alone） using a random number table, with 30 patients in each group. The degree of pain, postoperative sufentanil amount taken, postoperative hemodynamics, serum inflammatory factors and incidence of adverse reactions at different postoperative time points were compared between two groups. Result The VAS score of the patients in the combined group was significantly lower than that in the control group at 4, 8, 16 and 24 hours after operation（P〈0.05）. There was no significant difference observed in levels of SBP, HR and DBP between combined group and control group immediately and at 4, 8, 16 and 24 hours after surgery（P〈0.05）. The serum levels of TNF-α, IL-6 and IL-10 in combined group were lower than those in control group at 12 and 24 hours after surgery（P〈0.05）; The sufentanil amount taken during 24 hours after surgery and the incidences of adverse reactions in combined group were lower than those in control group（P〈0.05）.Conclusion The combination of PCIA and PVB has superior postoperative analgesic effect than PCIA alone in lung cancer patients, as well as a high safety.