ESPB复合全身麻醉对胸腔镜肺叶切除术患者围术期麻醉药物用量、血清SP-A及炎症因子的影响

Effects of ESPB Combined with General Anesthesia on Perioperative Anesthetic Dose,Serum SP-A and Inflammatory Factors in Patients Undergoing Thoracoscopic Lobectomy

目的观察超声引导竖脊肌平面阻滞(erector spinae plane block,ESPB)复合全身麻醉对胸腔镜肺叶切除术患者围术期麻醉药物用量、血清肺表面活性蛋白质A(surfactant protein A,SP-A)及炎症因子的影响。方法将80例择期进行胸腔镜肺叶切除术患者,应用随机数字表法分为对照组(n=40)和观察组(n=40);全身麻醉诱导后行超声引导ESPB,观察组予以20ml 0.5%罗哌卡因注射,对照组予以20ml生理盐水注射;两组术毕均以自控静脉镇痛泵。分别于术前24h及术后48h采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)测定血清SP-A、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白细胞介素6(interleukin-6,IL-6)、IL-8水平;并与术前24h及术后24h、48h采用40项恢复质量评分量表(40-itemquality of recovery score,QoR-40)评估患者术后恢复情况。记录患者围术期麻醉药物用量、术后补救镇痛及不良反应情况。结果术后48h,两组血清SP-A、TNF-α、IL-6及IL-8水平较术前均明显增高(P<0.05),且观察组上述指标均明显低于对照组(P<0.05)。与对照组比较,观察组术中瑞芬太尼用量及术后舒芬太尼用量均明显减少,术后补救镇痛率明显降低,术后24h及48h的QoR-40评分均明显增高,且术后恶心呕吐发生率明显降低,差异均有统计学意义(P<0.05)。结论超声引导ESPB复合全身麻醉能减少胸腔镜肺叶切除术患者围术期麻醉药物用量,抑制炎症反应及SP-A的表达,促进患者术后早日好转。

Objective To observe the effects of ultrasound-guided erector spinae plane block(ESPB)combined with general anesthesia on perioperative anesthetic dose,serum pulmonary surfactant protein A(SP-A)and inflammatory factors in patients underwent thoracoscopic lobectomy.Methods Eighty patients who underwent elective thoracoscopic lobectomy were divided into control group(n=40)and observation group(n=40)by random number table method.After induction of general anesthesia,ultrasound-guided ESPB was performed,the patients of observation group were given 20ml of 0.5%ropivacaine injection,and control group was injected with 20ml of normal saline,and both groups were connected with a self-controlled intravenous analgesia pump.Serum levels of SP-A,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-8were measured by enzyme-linked immunosorbent assay(ELISA)at pre-operation 24hand post-operation 48h,respectively.The post-operation recovery quality at pre-operation 24hand post-operation 24hand 48hwere evaluated by 40items of quality of recovery score(QoR-40).The perioperative anesthetic dose,postoperative remedial analgesia and adverse reactions were recorded.Results At 48hafter operation,serum levels of SP-A,TNF-α,IL-6and IL-8in the two groups were significantly higher than those of pre-operation(P<0.05),and the above indexes in observation group were significantly lower than those of control group(P<0.05).Compared with control group,the dose of intraoperative remifentanil and postoperative sufentanil were significantly reduced in observation group,the postoperative remedial analgesia rate was significantly decreased,and the QoR-40scores were significantly increased at 24h and 48hafter operation,and the incidence rates of postoperative nausea and vomiting were significantly decreased(P<0.05).Conclusion Ultrasound-guided ESPB combined with general anesthesia for patients undergoing thoracoscopic lobectomy can reduce the perioperative anesthetic dose,inhibit the inflammatory response and increase the SP-A expression,and have a positive effect on promoting early postoperative outcomes.