超声引导下胸椎旁神经阻滞联合全麻对腔镜下肺癌根治术患者术后谵妄及苏醒质量的影响

Effect of ultrasound-guided thoracic paravertebral nerveblock combined with general anesthesia on the quality of recovery and postoperative delirium in patients undergone thoracoscopic radical resection of lung cancer

目的:探讨超声引导下全身麻醉(简称全麻)联合胸椎旁神经阻滞对腔镜下肺癌根治术患者术后谵妄及苏醒质量的影响。方法:将60例全麻下行胸腔镜下肺癌根治术患者按随机数字表法分为全麻联合胸椎旁神经阻滞组(P组)和单纯全麻组(C组),每组30例。P组麻醉诱导前侧卧位,术侧向上,根据手术部位选择T4或T5及T8椎旁行两点阻滞法;C组不做任何处理。记录瑞芬太尼和丙泊酚消耗量、手术时间、术中失血量;记录自主呼吸恢复时间、拔管时间,清醒时间及气管拔管后10 min、20 min术后躁动情况;记录患者在术后1 d、2 d和3 d发生谵妄的情况及术后2 h、6 h、12 h、24 h、48 h VAS评分,术后12 h、24 h及48 h静脉镇痛自控泵按压次数及术后补救镇痛药物总量(VAS评分≥4分,静脉注射曲马多1 mg·kg^(-1)补救镇痛)。结果:两组患者手术时间及出血量差异无统计学意义(P>0.05);P组患者自主呼吸恢复时间、苏醒时间、拔管时间均低于C组(P<0.05),P组术后SAS评分明显降低(P>0.05);P组患者瑞芬太尼及丙泊酚用量少于C组(P<0.05);P组患者术后2 h、6 h、12 h咳嗽时VAS评分、术后12 h PCA按压次数及术后48 h总补救镇痛率和术后1 d、2 d术后谵妄发生率均低于C组(P均<0.05)。结论:全身麻醉联合胸椎旁神经阻滞应用于胸腔镜肺癌根治术患者可获得满意的术中及术后镇痛,减少全身麻醉药的使用量,提高苏醒质量,降低患者术后谵妄的发生率。

Objective:To investigate the effect of ultrasound-guided thoracic paravertebral nerve block with general anesthesia on the quality of recovery and postoperative delirium in patients undergone thoracoscopic radical resection of lung cancer.Methods:A total of 60 patients with lung cancer underwent thoracoscopic radical resection under general anesthesia.They were randomly divided into thoracic paravertebral nerve block group(Group P)and single general anesthesia group(Group C),30 cases in each group.In Group P,the lateral position was taken before anesthesia induction,and two-point block was performed at T4,T5 and T8 according to the operation site,but single generalanesthesia group did not receive any treatment.The total dosage of remifentanil and propofol during the operation,operation time,intraoperative blood loss were recorded.The spontaneous breathing recovery,extubation time,recovery time,postoperative agitation were observed and recorded.The VAS scores at 2 h,6 h,12 h,24 h,36 h after operation,the times of pressing self-control intravenous analgesia pump at 12 h,24 h and 48 h after operation,the total amount of postoperative remedial analgesic drugs(VAS score≥4 points,intravenous tramadol 1 mg·kg^(-1) for rescue analgesia)were recorded.Delirium was recorded on the 1 st,2 nt,3 dday of post-operation.Results:There was no significant difference in operation time and blood loss between the two groups(P>0.05).The spontaneous breathing recovery,extubation time,recovery time in group P was significantly less than that in Group C(P<0.05),The SAS score in group P was was significantly less than that in Group C(P<0.05),The dosage of remifentanil and propofol in group P was significantly less than that in group C(P<0.05).The VAS score of cough in group P was significantly lower than that in group C at 2 h,6 h and 12 h after operation(P<0.05).The times of PCA pressing at 12 h after operation and the total rescue analgesia rate at 48 h after operation in group P were significantly lower than those in group C(P<0.05).The incidence of post operation delirium in group P were significantly lower than that in group C during postoperation 48 h(P<0.05).Conclusion:Thoracic paraspinal nerve block combined with general anesthesia can provide satisfactory analgesia during and after operation,reduce the usage of general anesthetics and reduce the incidence of POD in patients undergone thoracoscopic radical resection of lung cancer,which is worthy of clinical application.