超声引导下不同神经阻滞方法在胸腔镜肺癌根治术患者术后镇痛中的应用效果观察

Observation on the Application Effects of Different Approaches to Ultrasound-guided Nerve Block in Postoperative Analgesia of Patients Undergoing Thoracoscopic Radical Surgery for Lung Cancer

目的探讨超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)和胸椎旁神经阻滞(thoracic paravertebral block,TPVB)在胸腔镜肺癌根治术患者术后镇痛中的应用效果。方法选取符合纳入及排除标准的择期行胸腔镜肺癌根治术的肺癌125例,根据神经阻滞方法选择意愿,非随机分为ESPB组60例和TPVB组65例。ESPB组接受超声引导下ESPB,TPVB组接受超声引导下TPVB。比较两组麻醉前、麻醉10 min时、麻醉60 min时及手术结束时心率和血压,术后1、6、12、24及48 h静息和咳嗽时疼痛程度,术后48 h内自控镇痛(PCA)按压次数和使用药物剂量,以及术后并发症和麻醉药物不良反应发生情况。结果两组麻醉前、麻醉10 min时、麻醉60 min时及手术结束时心率和血压比较差异均无统计学意义(P>0.05)。术后1、6、12、24及48 h静息和咳嗽时疼痛数字评分法评分ESPB组均低于TPVB组,差异有统计学意义(P<0.05或P<0.01)。术后48 h内,ESPB组PCA按压次数和使用药物剂量均少于TPVB组,差异有统计学意义(P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论与超声引导下TPVB比较,超声引导下ESPB应用于胸腔镜肺癌根治术患者术后镇痛效果好,且操作简单、易行、安全。

Objective To investigate the application effects of ultrasound-guided erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in postoperative analgesia of patients undergoing thoracoscopic radical surgery for lung cancer.Methods The study subjects were 125 patients who underwent elective thoracoscopic radical surgery for lung cancer and met with the inclusion and exclusion criteria.According to the nerve block method chosen by the patient,they were divided into ESPB group(n=60)and TPVB group(n=65).The ESPB group and TPVB group were given ultrasound-guided ESPB and ultrasound-guided TPVB,respectively.Comparisons between the 2 groups were made in terms of heart rate(HR)and blood pressure(BP)before anesthesia,at 10 min and 60 min after anesthesia and at the end of surgery.Pain of patients in rest state and while coughing at 1,6,12,24 and 48 h after surgery,average pressing frequency and dose of patient-controlled analgesia(PCA)within 48 h after surgery,postoperative complications and incidence of adverse reactions of anesthetics were compared.Results There was no significant difference in HR or BP between the two groups before anesthesia,at 10 min and 60 min after anesthesia and at the end of surgery(P>0.05).The numerical rating scale(NRS)scores of ESPB group in rest state and while coughing at 1,6,12,24,and 48 h after surgery were lower than those of TPVB group(P<0.05 or P<0.01).The average pressing frequency and dose of PCA in ESPB group within 48 h after surgery were less than those in TPVB group(P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with ultrasound-guided TPVB,ultrasound-guided ESPB can have a better analgesic effect after thoracoscopic radical surgery for lung cancer with good operability and safety.