罗哌卡因肋间神经阻滞在胸腔镜术后多模式镇痛作用

Effect of ropivacaine intercostal nerve block in multimodal analgesia during postoperative of thoracoscopic surgery

目的探讨罗哌卡因肋间神经阻滞在胸腔镜术后多模式镇痛中的作用及对疼痛指标的影响。方法纳入医院胸外科接受胸腔镜手术患者共120例,采用随机数字表法分为肋间神经阻滞组及对照组,观察并记录术后患者疼痛VAS评分、BCS评分、阿片类药物使用量及镇痛相关不良反应率,同时检测疼痛血清学指标SP、PGE2、IL-6以及CD4+、CD8+、CD4+/CD8+进行对比。结果 2组的VAS评分及BCS评分,24h内各时间点神经阻滞组均优于对照组(P<0.05)。神经阻滞组术后12,24和48h血清中疼痛指标水平明显低于对照组(P<0.05)。2组的CD4+、CD4+/CD8+相比神经阻滞组均高于对照组(P<0.05)。2组的舒芬太尼用量在12,24和48h各时间点神经阻滞组均低于对照组(P<0.05)。肋间神经阻滞组恶心呕吐、皮肤瘙痒和尿储留发生率分别为3.33%,0%和0%,低于对照组的10.00%,0%和1.66%,差异无统计学意义。术后48h哌替啶在肋间神经阻滞组及对照组使用次数分别为6和16次(P<0.05)。结论罗哌卡因肋间神经阻滞在胸腔镜术后多模式镇痛效果确切,可优化术后镇痛模式,对患者的免疫功能有保护作用,是一种可在临床推广的镇痛方法。

Objective To observe the effects of ropivacaine intercostal nerve block in multimodal analgesia during postoperative of thoracoscopic surgery and pain index.Methods 120 cases of patients who underwent the thoracopic surgery in the hospital were randomly divided into 2 groups.Patient in the observation group（60 cases）accepted intercostal nerve block,while the control group did not.Visual analogue scales（VAS）scores and bruggrmann comfort scales（BCS）scores were recorded at 3,6,9,12,24,48 and 72 hpostoperatively and the dose of opioids and side effects was also recorded.Serum pain indicators of cardiomyocyte substance（SP）,interleukin-6（IL-6）and prostaglandin E2（PGE2）were detected before operation and at postoperative 12,24 and 48 h.Meanwhile,CD4＋,CD8＋ and CD4＋/CD8＋were detected before operation and at postoperative 24 and 48 h.Results The mean VAS scores and BCS scores at each time of intercostal nerve block group were lower than of the control group,but only the hours within 24 hpostoperation were significant different（P〈0.05）.The control group used more opioids than the intercostal nerve block group,and had a higher rate of vomit and nausea,skin itching and urinary retention.Serum IL-6,SP,and PGE2 levels at postoperative 12,24 and 48 hin the observation group were significantly lower than those in the control group,the difference was statistically significant（P〈0.05）.Specific immune response indexes CD4＋ and CD4＋/CD8＋in peripheral blood of intercostal nerve block group were significantly higher than those of control group（P〈0.05）.Conclusion Ropivacaine intercostal nerve block can reduce the patient′s pain and alleviate the inhibition on the immune response system in multimodal analgesia during postoperative of thoracoscopic surgery,which is suitable for clinical application and promotion.