超声引导下胸椎旁神经阻滞联合全身麻醉在结核性脓胸患者胸腔镜手术中的应用效果

Application effect of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia in patients with tuberculous empyema undergoing thoracoscopic surgery

目的探讨超声引导下胸椎旁神经阻滞联合全身麻醉在结核性脓胸患者胸腔镜手术中的应用效果。方法将行胸腔镜手术治疗的80例结核性脓胸患者随机分为观察组与对照组,各40例。对照组采用常规气管插管全身麻醉,观察组采用超声引导下胸椎旁神经阻滞联合气管插管全身麻醉,两组患者术后均使用静脉自控镇痛泵。比较两组患者麻醉诱导时(T_(0))、手术进行1 h(T_(1))、术后6 h(T_(2))、术后24 h(T_(3))时的血清谷丙转氨酶水平;比较两组患者术后6 h时的血清超氧化物歧化酶(SOD)、白细胞介素(IL)-6和致痛物质P物质(SP)水平;比较两组患者术后24 h时静息和咳嗽时的疼痛数字量表(NRS)评分,以及术后48 h内麻醉相关并发症的发生情况。结果在T_(1)~T_(3)时,观察组患者的血清谷丙转氨酶水平均低于对照组(均P<0.05);术后6 h时,观察组患者的血清SOD水平高于对照组,而IL-6及SP水平均低于对照组(均P<0.05);术后24 h时,观察组患者静息时及咳嗽时的疼痛NRS评分均低于对照组(均P<0.05);术后48 h时,观察组术后麻醉相关并发症发生率低于对照组(P<0.05)。结论结核性脓胸患者行胸腔镜手术时采用超声引导下胸椎旁神经阻滞联合全身麻醉,可减轻患者围术期炎症反应,提高机体抗氧化能力,减轻术后疼痛,改善肝功能,有助于患者术后快速康复,安全性高。

Objective To investigate the application effect of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia in patients with tuberculous empyema undergoing thoracoscopic surgery.Methods Eighty patients with tuberculous empyema scheduled for thoracoscopic surgery were randomly divided into observation group(n=40)and control group(n=40).The control group received general anesthesia with conventional endotracheal intubation,and the observation group received ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia(with endotracheal intubation).Patients in both groups used patient-controlled intravenous analgesia pumps after the operation.Serum ALT levels at anesthesia induction(T_(0)),one hour of the operation(T_(1)),six hours after the operation(T_(2))and 24 hours after the operation(T_(3))were compared between the two groups;serum levels of superoxide dismutase(SOD),interleukin(IL)-6,and algogenic substance P(SP)six hours after the operation were compared between the two groups;and the Numerical Rating Scale(NRS)scores for pain at rest and when coughing 24 hours after the operation and the incidence of anesthesia-related complications within 48 hours after the operation were compared between the two groups.Results Between T_(1)and T_(3),the observation group yielded lower serum ALT levels than the control group(all P<0.05).Six hours after the operation,serum SOD level was higher and the levels of IL-6 and SP were lower in the observation group than in the control group(all P<0.05);twenty-four hours after the operation,the observation group obtained lower NRS scores for pain at rest and when coughing than the control group(all P<0.05);forty-eight hours after the operation,the observation group exhibited a lower incidence rate of postoperative anesthesia-related complications than the control group(P<0.05).Conclusion The application of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia in the thoracoscopic surgery for patients with tuberculous empyema can reduce patients′perioperative inflammatory reaction,improve body′s antioxidant capacity,reduce postoperative pain,improve liver function,and contribute to the rapid postoperative recovery for patients,with high safety.