超声引导联合全身麻醉对高龄肺癌肺叶切除术患者的术中镇痛效果及术后早期转归的影响

Effect of ultrasound-guided erector spinae plane block combined with general anesthesia on intraoperative analgesia and early postoperative outcomes in patients undergoing lobectomy for lung cancer

目的:探讨超声引导竖脊肌平面阻滞联合全身麻醉对75岁以上高龄肺癌肺叶切除术患者术中镇痛效果及术后早期转归的影响。方法:分析2018年6月至2019年6月西南医科大学附属医院收治的75岁以上高龄肺癌患者63例,均拟行肺叶切除术,按照随机数字表法分为对照组31例、观察组32例。对照组采用全身麻醉,观察组采用超声引导竖脊肌平面阻滞联合全身麻醉,比较两组手术相关指标及术后苏醒时间、术后住院时间、术中不同时间点平均动脉压和心率变化、术后肺活量、术后镇痛效果、术后康复质量、术后认知功能障碍及不良反应的发生情况。结果:两组手术时间、麻醉时间、苏醒时间、术后住院时间差异无统计学意义(P>0.05);观察组插管时、切皮时、拔管时的平均动脉压、心率均低于对照组(P<0.05);观察组术后12、24、48 h的肺活量均高于对照组(P<0.05);观察组术后镇痛补救率、镇痛泵按压次数、输注总量、术后6 h和术后12 h VAS评分均少于对照组(P<0.05);观察组术后24、48、72 h的康复质量评分均高于对照组(P<0.05);观察组术后6、12、24 h的认知功能障碍发生率低于对照组(P<0.05);观察组术后不良反应总发生率为37.50%,低于对照组的70.97%(P<0.05)。结论:超声引导竖脊肌平面阻滞联合全身麻醉应用于75岁以上高龄肺癌肺叶切除术患者术中镇痛效果确切,术中患者生命体征变化相对平稳,术后肺功能恢复快,术后康复质量较好,术后镇痛补救率低,疼痛轻,术后认知功能障碍发生率低,不良反应少,麻醉效果确切且风险低,安全性好。

Objective:To investigate the effect of ultrasound-guided erector spinae plane block combined with general anesthesia on intraoperative analgesia and early postoperative outcomes in patients aged over 75 years undergoing lobectomy for lung cancer.Methods:In this study,we enrolled 63 patients with advanced lung cancer aged 75 years and older who were admitted to The Affiliated Hospital of Southwest Medical University between June 2018 and June 2019.All patients underwent lobectomy.Using the random number table method,patients were assigned into the control group(31 cases)and the observation group(32 cases).The control group received general anesthesia,while the observation group received ultrasound-guided erector spinae plane block in combination with general anesthesia.Operation-related indexes,postoperative recovery time,postoperative duration of hospitalization,changes in mean arterial pressure and heart rate at different time points during the operation,dosage of remifentanil during the operation,postoperative vital capacity,postoperative analgesic effects,postoperative rehabilitation quality,postoperative cognitive function,and adverse reactions were compared between the two groups.Results:There was no significant difference in operative time,anesthesia time,postoperative recovery time,or postoperative duration of hospitalization between the two groups(P>0.05).The mean arterial pressure and heart rate in the observation group were lower than those in the control group(P<0.05)during intubation,skin cutting,and extubation;the vital capacities at 12 h,24 h,and 48 h after the operation were higher in the observation group than in the control group(P<0.05);the remediation rate of postoperative analgesia,number of compressions of the analgesia pump,total infusion volume,the visual analog scale scores at 6 h,12 h,and 72 h post-operation in the observation group were lower than those in the control group(P<0.05);the scores for rehabilitation quality at 24 h,48 h,and 72 h post-operation in the observation group were higher than those in the control group(P<0.05).The incidence of cognitive dysfunction at 6 h,12 h,and 24 h post-operation in the observation group was lower than that in the control group(P<0.05).The overall incidence of adverse reactions was 37.50%and 70.97%in the observation and control groups,respectively(P<0.05).Conclusions:Ultrasound-guided erector spinae plane block combined with general anesthesia is effective for patients over 75 years of age undergoing lobectomy for lung cancer.The intraoperative analgesia is relatively stable.Furthermore,the patients'vital signs during operation are relatively stable,and the postoperative recovery of lung function is rapid.Other advantages of this approach include good quality of rehabilitation,low rate of postoperative analgesic remediation,an accurate anesthetic effect,low risk,and safety.In addition,patients only experience mild pain,have a low incidence of postoperative cognitive dysfunction,and have fewer adverse reactions.Therefore,it is worth promoting this approach.