前锯肌阻滞对非气管插管经胸腔镜肺癌根治术应激反应的影响分析

Effect of anterior serratus block on stress response of non-tracheal intubation thoracoscopic radical resection of lung cancer

目的探究前锯肌阻滞在非气管插管经胸腔镜肺癌根治术镇痛中的效果以及对患者应激反应的影响。方法选取2016年1月至2018年12月于浙江省台州医院择期行非气管插管经胸腔镜肺癌根治术的患者64例,采用随机数字表法分为观察组和对照组,每组32例。所有患者术中均实施静吸复合全身麻醉,术后给予静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),观察组患者在全身麻醉后实施超声引导下前锯肌阻滞。比较两组患者术中、术后24h舒芬太尼及丙泊酚用量,术后患者苏醒时间,拔管时间以及PCIA按压次数,记录术中及术后不良反应发生情况,于术后不同时间(12、24、48h)评价患者疼痛视觉模拟评分(visual analogue scale,VAS)和恢复质量评分(quality of recovery 40,QoR-40)。术后24h测定血浆激素(多巴胺、肾上腺素、去甲肾上腺素、皮质醇和超敏C反应蛋白)水平,评价两组患者的应激反应情况。结果观察组术中及术后24h舒芬太尼用量低于对照组,术后苏醒时间及拔除喉罩时间短于对照组,PCIA按压次数少于对照组(P<0.05)。术后12、24、48h时,观察组VAS评分低于对照组,QoR-40评分高于对照组(P<0.05)。术后24h观察组血浆多巴胺、肾上腺素、去甲肾上腺素、皮质醇和超敏C反应蛋白水平均低于对照组(P均<0.05)。结论对于胸腔镜下行非气管插管肺癌根治术的患者,在全身麻醉后实施前锯肌阻滞可显著增强镇痛效果,减轻应激反应,安全可靠,值得临床推广。

Objective To investigate the effect of serratus anterior block on analgesia and stress response of patients after non-tracheal intubation thoracoscopic radical resection of lung cancer.Method 64 patients who underwent thoracoscopic non-tracheal intubation radical resection of lung cancer in our hospital from January 2016 to December 2018 were selected and divided into observation group and control group by random number table method.Postoperative patient-controlled analgesia(PCIA)was performed in all patients.After general anesthesia,ultrasound-guided serratus anterior blockade was performed in the observation group.Compare two groups intraoperative and postoperative 24 h sufentanil too,and the dosage of propofol,postoperatively,wake up of time,extubation time and number of PCIA press,intraoperative and postoperative adverse reactions,in the different time(12,24 and 48 h)evaluation of pain in patients with visual analogue scale(visual analogue scale,VAS)and restoring the quality score(quality of recovery,40 QoR-40).The stress response of the 2 groups was evaluated 24h after the operation by plasma hormone levels(dopamine,adrenalin,norepinephrine,cortisol and hypersensitive c-reactive protein).Result The intraoperative and postoperative sufentanil dosage in the observation group was lower than that in the control group,the postoperative recovery time and extubation time were shorter than that in the control group,and the PCIA compression frequency was lower than that in the control group(all P<0.05).At 12,24 and 48h after surgery,VAS scores of the observation group were lower than those of the control group,and QoR-40 was higher than those of the control group(all P<0.05).Plasma levels of dopamine,adrenalin,norepinephrine,cortisol and hypersensitive c-reactive protein in the observation group 24h after the operation were all lower than those in the control group(P<0.05).Conclusion For patients undergoing thoracoscopic non-tracheal intubation of lung cancer,serratus anterior block after general anesthesia can significantly enhance the analgesic effect and reduce the stress response of patients,which is safe and reliable and worthy of clinical promotion.