布托啡诺联合单次椎旁阻滞对行单操作孔电视胸腔镜肺叶切除术肺结核患者镇痛效果及Cor、PGE2和5-HT水平的影响

Effects of Butorphanol Combined with a Single Paravertebral Block on Analgesic Effect and the Levels of Cor,PGE and 5-HT in Pulmonary Tuberculosis Patients undergoing UVATS Lobectomy

目的:观察布托啡诺联合单次椎旁阻滞对行单操作孔电视胸腔镜(UVATS)肺叶切除术肺结核患者的镇痛效果及对血清皮质醇(Cor)、前列腺素E2(PGE2)和5-羟色胺(5-HT)水平的影响。方法:177例耐药结核患者随机分为对照组88例和观察组89例,两组患者均在麻醉诱导前给予0.5%罗哌卡因20 ml行单次胸椎旁阻滞,行UVATS肺叶切除术。观察组患者在胸椎旁阻滞前给予布托啡诺30μg·kg^(-1),术后给予舒芬太尼、托烷司琼行静脉自控镇痛(PCIA)。比较两组患者术后2,4,8,12,24,48 h视觉模拟评分法(VAS)评分、Ramsay镇静评分和PCIA按压次数;比较两组患者术前及术后12 h血清Cor、PGE2、5-HT水平变化;记录两组患者术后并发症发生情况。结果:术后各时点,观察组患者的VAS评分、PCIA按压次数均明显少于对照组(P<0.05),两组患者的Ramsay镇静评分差异无统计学意义(P>0.05)。两组患者术后12 h血清Cor、PGE2、5-HT水平均较术前明显升高(P<0.05),且观察组明显低于对照组(P<0.05)。两组患者术后并发症发生率差异无统计学意义(P>0.05)。结论:布托啡诺联合单次胸椎旁阻滞对行UVATS肺叶切除术的肺结核患者术后镇痛效果良好,能有效缓解患者术后机体疼痛程度,减少应激反应,值得临床应用。

Objective: To investigate the analgesic effects of butorphanol combined with a single paravertebral block in patients with tuberculosis undergoing uniportal video-assisted thoracoscopic(UVATS) lobectomy and the influence on the serum levels of cortisol(Cor),prostaglandin E2(PGE2) and 5-hydroxytryptamine(5-HT). Methods: Totally 177 patients with drug-resistant tuberculosis were divided into control group(88 cases) and observation group(89 cases) by digital randomization. The two groups of patients were performed a single thoracic paravertebral block by given 20 ml 0. 5% ropivacaine before anesthesia induction. The observation group was given 30 μg·kg^(-1) butorphanol before the thoracic paraspinal block,and sufentanil and tropisetron were used postoperatively by patient-controlled intravenous analgesia(PCIA). The visual analogue scores(VAS),Ramsay sedation scores and the number of PCIA compression between the two groups at 2 h,4 h,8 h,12 h,24 h and 48 h after surgery were compared,the levels of Cor,PGE2 and 5-HT in the two groups before surgery and at 12 h after surgery were compared as well. The adverse reactions were recorded after surgery. Results: The VAS and number of PCIA compression at each time point after surgery in the observation group were significantly lower than those in the control group(P<0. 05). There was no significant difference in the Ramsay sedation scores of the two groups at various points after surgery(P>0. 05). The serum levels of Cor,PGE2 and 5-HT in the observation group were significantly lower than those in the control group at 12 h after surgery(P< 0. 05),and the observation group was significantly lower than the control group(P<0. 05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0. 05).Conclusion: The opioid receptor agonist butorphanol combined with a single thoracic paravertebral block can be used clinically for postoperative analgesia in patients with tuberculosis undergoing single UVATS lobectomy. The analgesic effect is good and can effectively relieve the body pain and reduce the stress response,which is worthy of clinical application.