超声引导下ESPB和TPVB对单孔胸腔镜肺癌根治手术患者循环、炎性因子水平及术后镇痛的影响

Effect of ultrasound-guided ESPB and TPVB on circulation, inflammatory factors and postoperative analgesia in patients undergoing radical resection of lung cancer via single-hole thoracoscopy

目的探讨超声引导下竖脊肌平面阻滞(ESPB)和胸椎旁神经阻滞(TPVB)对单孔胸腔镜肺癌根治手术患者循环、炎性因子水平及术后镇痛的影响。方法单孔胸腔镜肺癌根治手术患者60例随机均分为三组。E组单用全身麻醉(全麻),C组加用ESPB,D组加用TPVB。术后行静脉患者自控镇痛(PCA)。手术前后检测血清CRP、TNF-α和皮质醇水平。记录进入手术室时(T0)、全麻诱导前(T1)、开始切皮时(T2)和手术结束时(T3)的MAP和HR,于术后2 h(T4)、6 h(T5)、12 h(T6)、24 h(T7)和48 h(T8)评估静息及咳嗽时的VAS疼痛评分。观察不良反应发生情况。结果与T0比较,D组T1时MAP降低,HR增加(P<0.05),E组T2、T3时MAP和HR增加(P<0.05)。C组和D组T2、T3时MAP、HR较E组降低(P<0.05);与D组相比,C组T1时MAP增加,HR降低(P<0.05)。与术前相比,三组术后CRP、TNF-α和皮质醇水平增加(P<0.05),E组增加更加明显(P<0.05)。与E组相比,C组和D组T4~T6时静息和咳嗽时VAS疼痛评分、PCA有效追加次数均减少(P<0.05);C组T7时静息时VAS疼痛评分亦低于E组(P<0.05)。E组恶心、呕吐发生率高于C组和D组(P<0.05);D组术中低血压发生率高于C组和E组(P<0.05)。结论在全麻单孔胸腔镜肺癌根治术患者,加用ESPB和TPVB能提供有效的术后镇痛,维持循环稳定,减轻手术应激反应,减少全麻药用量和不良反应。

Objective To investigate the effect of ultrasound-guided erector spinae plane block(ESPB) and thoracic paravertebral block(TPVB) on circulation, inflammatory factors and postoperative analgesia in patients undergoing radical resection of lung cancer via single-hole thoracoscopy.MethodsSixty patients undergoing radical resection of lung cancer via single-hole thoracoscopy under general anesthesia were equally randomized into three groups of C,D and E.General anesthesia alone was used in group E and groups of C and D were additionally combined with ESPB and TPVB,respectively.Postoperative intravenous patient-controlled analgesia(PCA) was used in three groups.Serum levels of CRP,TNF-α and cortisol were detected before and after operation.MAP and HR were recorded at the time points of entering operating room(T0),before anesthesia induction(T1),the beginning of skin incision(T2) and the end of operation(T3).The VAS pain scores at rest and cough were evaluated in the 2nd(T4),6th(T5),12th(T6),24th(T7) and 48th hour(T8) after operation were observed.The adverse responses were recorded.Results Compared with T0,MAP was decreased and HR was increased in group D at T1(P<0.05),and MAP and HR were increased in group E at T2 and T3(P<0.05).MAP and HR in groups of C and D were lower than those in group E at T2 and T3(P<0.05).Compared with group D,MAP was increased and HR was decreased in group C at T1(P<0.05).Compared with before, serum levels of CRP,TNF-α and cortisol were increased after operation in three groups(P<0.05),while which in group E were changed more obviously(P<0.05).Compared with group E,the VAS pain scores at rest and cough at T4-T6 were decreased in groups of C and D(P<0.05).The VAS pain score at rest in group C was lower than that in group E at T7(P<0.05).The incidence of nausea and vomiting in group E was higher than that in groups of C and D(P<0.05),while which of intraoperative hypotension in group D was higher than that in groups of C and E(P<0.05).Conclusion In the patients undergoing radical resection of lung cancer via single-hole thoracoscopy under general anesthesia, both of ESPB and TPVB can provide effective postoperative analgesia, maintain circulation stable, attenuate stress response and reduce anesthetics consumption and incidence of complications.