超声引导下胸椎旁神经阻滞对肺癌患者血流动力学、应激反应、术后痛敏反应和复苏质量的影响

Effect of ultrasound-guided paraspinal nerve block on postoperative hyperalgesia and resuscitation quality of patients with lung cancer

目的探讨超声引导下胸椎旁神经阻滞对肺癌患者血流动力学、术后痛敏反应和复苏质量的影响。方法前瞻性选取2019年5月至2021年5月在首都医科大学大兴教学医院住院治疗的行肺癌根治术患者100例,根据随机数字表法分为对照组和观察组,每组各50例。对照组患者采用单纯全身麻醉方式,观察组采用在超声引导下胸椎旁神经阻滞后行全身麻醉方式。对比两组患者的临床资料及进入手术室后5分(T0)、麻醉诱导后5分(T1)、切皮即刻(T2)、切皮后(T3)、手术结束即刻(T4)的血流动力学指标情况;比较诱导前或神经阻滞前30 min(t0)、切皮后1 h(t1)、术后2 h(t2)、术后24 h(t3)两组患者麻醉前后应激反应情况;比较两组患者的术后视觉模拟量表(VAS)评分、Ramsay镇静评分(RSS)、术后苏醒情况及术后并发症情况。结果观察组中的MAP和心率在T2~T4时显著低于对照组,差异均有统计学意义(P <0.05)。观察组中去甲肾上腺素、肾上腺素、血管紧张素Ⅱ和β内啡肽水平在t1、t2、t3时显著低于对照组,差异均有统计学意义(P <0.05)。观察组中的VAS疼痛评分低于对照组,差异有统计学意义(P <0.05);两组患者RSS评分比较,差异无统计学意义(P> 0.05)。观察组患者术后自主呼吸时间、苏醒时间、拔管时间、焦虑自评量表(SAS)评分均低于对照组患者,差异均有统计学意义(P <0.05)。观察组患者不良反应总发生率为10.00%,均低于对照组(26.00%),差异有统计学意义(P <0.05)。结论与单纯全身麻醉方式相比,肺癌根治术中采用超声引导下胸椎旁神经阻滞联合全身麻醉,能够稳定患者血流动力学,有效缓解应激反应和术后痛敏反应,术后苏醒较快,并发症发生率较低。

Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block on postoperative hyperalgesia and resuscitation quality of patients with lung cancer. Methods A total of 100 lung cancer patients who were hospitalized in the Daxing Teaching Hospital from May 2019 to May 2021 were prospectively selected and divided into a control group and an observation group according to the random number table method,with 50 cases in each group;the control group received general anesthesia The observation group used general anesthesia under ultrasound guidance for paravertebral nerve block. The clinical data and blood flow multi-mechanical indicators of the two groups of patients were observed and compared;the stress response of the two groups before and after anesthesia,the postoperative visual analog scale( VAS),Ramsay sedation score( RSS),postoperative recovery and postoperative complications of the two groups were compared. Results At T2-T4,the MAP and HR in the observation group were significantly lower than those in the control group,the differences were statistically significant( P <0. 05). The levels of norepinephrine,epinephrine,angiotensin II and β-endorphin in the observation group were significantly lower than those in the control group at t1,t2,and t3,the differences were statistically significant( P < 0. 05). The VAS pain scores in the observation group were lower than those in the control group group,the differences were statistically significant( P < 0. 05). There was no statistically significant difference in RSS scores between the two groups of patients( P > 0. 05). Postoperative spontaneous breathing time,wake-up time,extubation time,and self-rating anxiety scale( SAS) scores in the observation group were significantly lower than those in the control group,and the differences were statistically significant( P < 0. 05). The total incidence of adverse reactions in the observation group was 10. 0%,which was lower than that in the control group( 26. 0%),the difference was statistically significant( P < 0. 05). Conclusion Ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia can effectively alleviate postoperative hyperalgesia in patients with lung cancer,recover faster after surgery,and have a lower incidence of complications.