胸椎旁神经阻滞联合静脉自控镇痛在肺癌微创手术患者中的应用效果

The effect of thoracic paravertebral nerve block combined intravenous patient controlled analgesia in minimally invasive surgery for lung cancer

目的分析胸椎旁神经阻滞联合静脉自控镇痛在肺癌微创手术患者中的应用效果。方法选取2015年3月至2017年3月于该院接受治疗的107例肺癌患者为研究对象,按照随机数表法分为对照组53例,观察组54例。2组患者均接受静-吸复合全身麻醉。对照组进行芬太尼静脉自控镇痛,观察组进行胸椎旁神经阻滞联合静脉自控镇痛。比较2组患者不良反应发生率、疼痛评分、肿瘤标志物水平及肺功能。结果对照组与对照组不良反应发生率分别为34.0%、14.8%。术后2、12、24、48h观察组疼痛评分分别为(1.35±0.65)、(2.82±0.75)、(3.36±0.74)、(4.36±0.50)分,明显低于对照组的(4.36±0.50)、(3.25±0.45)、(4.26±0.75)、(5.15±0.35)分,差异均有统计学意义(P<0.05)。术后对照组癌胚抗原、糖类抗原125、神经元特异性烯醇化酶、细胞角质蛋白19片段分别为(4.15±2.06)ng/mL、(14.21±9.81)U/mL、(18.25±12.54)ng/mL、(2.84±1.41)ng/mL,明显高于术后观察组上述指标[(3.21±1.20)ng/mL、(12.24±8.32)U/mL、(16.25±11.36)ng/mL、(2.62±1.32)ng/mL],差异有统计学意义(P<0.05)。结论胸椎旁神经阻滞联合静脉自控镇痛用于肺癌微创手术时能够有效减少不良反应的发生,在肺癌微创手术患者中有良好的应用效果。

Objective To investigate the effect of thoracic paravertebral nerve block combined intravenous patient controlled analgesia in minimally invasive surgery for lung cancer. Methods From March 2015 to March 2017,107 lung cancer patients received minimally invasive surgery were selected as the subjects,and di vided into control group （53 cases） and observation group （54 cases） according random number table method. The control group received fentanyl controlled intravenous analgesia, and the observation group received tho racic paravertebral nerve block combined intravenous patient controlled analgesia. Incidence rate of adverse re actions, the pain scores, levels of tumor markers, pulmonary function were compared in the two groups. Results Theincidence rate of adverse reaction of the control group and observation group were 34. 0±, 14.8± respectively. The pain score in the observation group were（1. 35 ± 0. 56）, （2. 82 ± 0. 75）, （3.36± 0.74） , （4.36±0.50） ,which were significant lower than （4.36±0.50） , （3.25±0.45） , （4.26±0.75） , （5.15± 0.35） in the control group （P±0.05）. After operation, the level of carcinoembryonic antigen, carbohydrate antigen 125 ,neuron specific enolase,cytokeratin 19 fragment in the control group were （4.15±2.06）ng/mL, （14.21±9.81）U/mL, （18. 25±12. 54）ng/mL, （2. 84±1. 41）ng/mL,which were significant lower than （3.21±1.20）ng/mL, （12.24±8.32）U/mL, （16.25 ± 11.36）ng/mL, （2. 62± 1. 32）ng/mL in the observation group（P±0.05）. Conclusion Thoracic paravertebral nerve block combined intravenous patient controlled an algesia in minimally invasive surgery for lung cancer can effectively reduce the incidence rate of adverse reac tions,has good application effect in lung cancer patients with minimally invasive surgery.