椎旁神经阻滞对肺癌患者肺叶切除术后的镇痛效果研究

Analgesic effect of paravertebral nerve block in patients with lung cancer after lobectomy

目的探讨椎旁神经阻滞对肺癌患者肺叶切除术后的镇痛效果。方法选取60例拟实施肺叶切除术的肺癌患者,采用随机数字表法将患者随机分为研究组和对照组,每组30例。研究组患者接受椎旁神经阻滞复合全身麻醉下肺叶切除术,对照组患者接受单纯全身麻醉下肺叶切除术,两组患者术毕均行静脉自控镇痛(PCIA)。对比两组患者术后不同时间点的疼痛程度评分、镇痛泵按压次数、舒芬太尼用量及血清炎性因子水平。结果所有患者术后不同时间点视觉模拟评分法(VAS)评分比较,差异有统计学意义(P﹤0.01);术后,两组患者的VAS评分比较,差异有统计学意义(P﹤0.01);时间和组别间存在交互效应(P﹤0.01)。术后24、48 h,研究组患者的镇痛泵按压次数、舒芬太尼用量均明显低于同时间点对照组患者(P﹤0.01)。术前,两组患者的血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平比较,差异均无统计学意义(P﹥0.05);术后48 h,研究组患者的血清IL-6、IL-10、TNF-α水平均明显低于对照组(P﹤0.01)。研究组患者的不良反应发生率与对照组比较,差异无统计学意义(P﹥0.05)。结论椎旁神经阻滞复合全身麻醉下实施肺叶切除术不仅有利于术后镇痛效果的提升,而且还能够减少舒芬太尼用量,减轻手术引起的炎性反应程度。

Objective To explore the analgesic effect of paravertebral nerve block in lung cancer patients after lobectomy. Method Sixty patients with lung cancer who were administered with lobectomy were randomly assigned to study group and control group using a random number table, with 30 in each group. Patients in the study group underwent paravertebral nerve block combined with general anesthesia for lobectomy, and patients in the control group received general anesthesia for lobectomy alone. Both groups were administered with postoperative patient-controlled intravenous analgesia (PCIA). The visual analogue scale (VAS) for pain, the number of analgesic pump presses, dose of sufentanil, and serum inflammatory factors were compared between the two groups at different time points. Result VAS scores of all patients at different postoperative time points were compared, and the difference was statistically significant (P<0.01);furthermore, after surgery, the VAS scores of the two groups were compared, and the difference was statistically significant (P<0.01);interaction effect was noted between time and groups (P<0.01). At 24 h and 48 h after surgery, the number of analgesic pump presses and the dose of sufentanil in the study group were significantly lower than those in the control group (P<0.01). There were no significant differences in serum interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α(TNF-α) levels between the two groups before surgery (P>0.05);while at 48 h after surgery, the serum levels of IL-6, IL-10 and TNF-α in study group were significantly lower than those in control group (P<0.01). There was no significant difference regarding the incidence of adverse reactions between study group and control group (P>0.05). Conclusion Paravertebral nerve block combined with general anesthesia for lobectomy is not only beneficial to the improvement of postoperative analgesia, but also can reduce the dosage of sufentanil and lower the degree of inflammatory reactions caused by surgery.