胸椎旁神经阻滞应用于全麻胸腔镜肺部手术患者中的作用

The role of thoracic paravertebral block in patients undergoing thoracoscopic pulmonary surgery under general anesthesia

目的探究胸椎旁神经阻滞(TPVB)应用于全身麻醉(全麻)胸腔镜肺部手术患者中的效果。方法 104例全麻胸腔镜肺部手术患者,随机分为试验组与对照组,每组52例。对照组未应用术前药物,试验组行超声引导下TPVB。比较两组术后24 h(T_(2))、术后48 h(T_(3))时段自控静脉镇痛(PCIA)按压次数、地佐辛输注总量,两组术后2、12、24、48 h的视觉模拟评分法(VAS)评分,两组炎症因子水平及不良反应发生率。结果试验组T_(2)、T_(3)时段PCIA按压次数、地佐辛输注总量均少于对照组,差异有统计学意义(P<0.05)。试验组术后2、12、24、48 h的VAS评分分别为(2.45±0.32)、(1.68±0.22)、(1.09±0.15)、(0.92±0.11)分,均低于对照组的(3.18±0.41)、(2.54±0.35)、(1.72±0.24)、(1.26±0.15)分,差异有统计学意义(P<0.05)。试验组白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异均有统计学意义(P<0.05)。试验组不良反应发生率为5.77%(3/52),低于对照组的19.23%(10/52),差异有统计学意义(P<0.05)。结论 TPVB对于全麻胸腔镜肺部手术患者具有实施价值。

Objective To investigate the effect of thoracic paravertebral block(TPVB)in patients undergoing thoracoscopic pulmonary surgery under general anesthesia.Methods A total of 104 patients with thoracoscopic pulmonary surgery under general anesthesia were randomly divided into experimental group and control group,with 52 cases in each group.The control group received no preoperative medication,and the experimental group received ultrasound-guided TPVB.The patient-controlled intravenous analgesia(PCIA)compressions,total amount of dezocine infusion at 24 h after operation(T_(2))and 48 h after operation(T_(3)),visual analogue scale(VAS)score at 2,12,24 and 48 h after operation,inflammatory factor levels and occurrence of adverse reactions were compared between the two groups.Results The number of PCIA compressions at T_(2) and T_(3) and the total amount of dezocine infusion in the experimental group were less than those in the control group,and the difference was statistically significant(P<0.05).The VAS score at 2,12,24 and 48 h after operation of the experimental group were(2.45±0.32),(1.68±0.22),(1.09±0.15)and(0.92±0.11)points,which were all lower than(3.18±0.41),(2.54±0.35),(1.72±0.24)and(1.26±0.15)points of the control group,and the difference was statistically significant(P<0.05).The levels of interleukin-6(IL-6),interleukin-10(IL-10),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)of the experimental group were lower than those of the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reaction of the experimental group was 5.77%(3/52),which was lower than 19.23%(10/52)of the control group,and the difference was statistically significant(P<0.05).Conclusion Thoracic paravertebral block is of practical value for patients undergoing thoracoscopic pulmonary surgery under general anesthesia.