超声引导胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者术中镇痛药物使用量及氧化应激反应的影响

Effect of ultrasound-guided thoracic paravertebral block combined with general anesthesia on analgesics use and oxidative stress in patients undergoing thoracoscopic radical resection of lung cancer

目的:探讨超声引导胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者术中镇痛药物使用量及氧化应激反应的影响。方法:选取2019年3月~2020年3月期间收治的110例行胸腔镜肺癌根治术患者为研究对象,按照随机数表法分为研究组与对照组各55例,对照组采用全身麻醉联合术后静脉镇痛,研究组在对照组基础上联合超声引导胸椎旁神经阻滞。比较两组患者镇痛药物使用情况(术后瑞芬太尼用量、术后静脉自控泵按压次数)评估差异;比较术后2h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4),两组患者术后疼痛程度[视觉模拟评分量表(VAS)]评估变化;比较术后7 d内,两组患者术后不良反应(恶心、呕吐、嗜睡)发生情况差异;比较术前及术后24 h时,两组患者氧化应激反应[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平变化。结果:研究组患者术中瑞芬太尼用量明显少于对照组(P<0.05),术后24 h内、48 h内,研究组患者术后静脉自控泵按压次数明显少于对照组(P<0.05);T1、T2、T3时,研究组患者VAS评分均明显低于对照组(P<0.05),而T4时两组患者VAS评分比较无统计学意义(P>0.05);术后7 d内,两组患者恶心、呕吐发生率比较无统计学意义(P>0.05),而研究组患者嗜睡发生率明显低于对照组(P<0.05);术后24 h时,研究组MDA水平与术前比较无统计学意义(P>0.05),而对照组较术前显著升高(P<0.05),研究组明显低于于同一时间对照组(P<0.05);两组患者SOD水平较术前显著降低(P<0.05),且研究组明显低于同一时间对照组(P<0.05)。结论:胸腔镜肺癌根治术患者采用超声引导胸椎旁神经阻滞复合全身麻醉,有助于减少镇痛药物用量,有效降低术后疼痛程度,减少患者术后不良反应及氧化应激状态。

Objective:To investigate the effect of ultrasound-guided thoracic paravertebral block combined with general anesthesia on analgesics use and oxidative stress in patients undergoing thoracoscopic radical resection of lung cancer.Methods:A total of 110 patients who underwent thoracoscopic radical resection of lung cancer between March 2019 and March 2020 in our hospital were included as subjects.According to random number table,the subjects were divided into the study group and control group(n=55 each).The control group received general anesthesia combined with postoperative intravenous analgesia,while the study group received ultrasound-guided thoracic paravertebral block in addition to the management in the control group.The analgesics use,as measured by postoperative remifentanil dosage,pressing of the automated pump for postoperative intravenous analgesia,was compared between the two groups.The degree of postoperative pain,as evaluated by visual analog scale(VAS),was compared between groups at 2h(T1),12 h(T2),24 h(T3),and 48 h(T4)postoperatively.Adverse reactions(nausea,vomiting,drowsiness)within seven days after surgery was compared between groups.Oxidative stress response,as reflected by the levels of malondialdehyde(MDA)and superoxide dismutase(SOD),were compared between groups before and at 24 h after the operation.Results:The intraoperative dosage of remifentanil in the study group was significantly less than that in the control group(P<0.05).Within 24 h and 48 h after the operation,study group reported significantly less pressing of the patient-control intravenous analgesia pump than did the control group(P<0.05).At T1,T2,and T3,the VAS scores in the study group were significantly lower than those in the control group(P<0.05),but there was no statistical difference between groups at T4(P>0.05).Within seven postoperative days,the two groups did not differ significantly in the incidence of nausea and vomiting(P>0.05),but the study group reported significantly less drowsiness than did the control group(P<0.05).At 24 h after operation,the MDA level was not significantly changed in the study group(P>0.05)but was elevated from baseline in the control group(P<0.05),and was significantly lower in the study group compared with the control group at any given time point(P<0.05);the SOD level was significantly lowered from baseline in either group(P<0.05),and was significantly lower in the study group compared with the control group at any given time point(P<0.05).Conclusion:In patients undergoing thoracoscopic radical resection of lung cancer,ultrasound-guided thoracic paravertebral block combined with general anesthesia may help effectively reduce analgesics use,postoperative pain,as well as adverse reactions and oxidative stress after surgery.