0.375%罗哌卡因联合帕瑞昔布钠前锯肌平面阻滞对胸腔镜手术术后疼痛的影响

Effect of 0. 375% ropivacaine combined with parecoxib sodium serratus anterior plane block on postoperative pain after thoracoscopic surgery

目的探讨0.375%罗哌卡因联合帕瑞昔布钠前锯肌平面阻滞对胸腔镜手术术后疼痛的影响。方法将80例胸腔镜下肺癌根治术患者用随机数字表法分为对照组(n=40)和试验组(n=40)。2组患者术前均给予常规检查,所有患者进行超声引导下单侧前锯肌平面阻滞和0.375%罗哌卡因及麻醉诱导、维持、苏醒。试验组分别在术前和术后24 h注射帕瑞昔布钠,对照组在全身麻醉前给予0.9%Na Cl。比较2组患者术前、术后平均动脉压(MAP)、心率(HR)、血浆皮质醇(Cor)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平和术后视觉模拟评分(VAS)、舒适度评分(BCS)。结果试验组和对照组T4时间MAP分别为(87.56±7.53)和(88.95±8.36)mm Hg,HR分别为(87.59±8.25)和(89.25±8.01)beat·min^(-1),差异均无统计学意义(均P>0.05)。治疗后,试验组和对照组的24 h VAS分别为(2.59±0.37)和(3.01±0.36)分,24 h BCS分别为(2.26±0.35)和(2.12±0.25)分,血浆Cor分别为(231.58±46.96)和(252.97±46.59)ng·mL^(-1),IL-6分别为(35.58±3.01)和(39.58±2.59)pg·mL^(-1),TNF-α分别为(6.39±0.72)和(10.36±0.68)pg·mL^(-1),差异均有统计学意义(均P<0.05)。结论0.375%罗哌卡因联合帕瑞昔布钠前锯肌平面阻滞对胸腔镜手术患者减轻术后疼痛,改善临床症状,有效控制安全性,提高患者的满意度。

Objective To explore the effect of 0. 375% ropivacaine combined with parecoxib sodium serratus anterior plane block on postoperative pain after thoracoscopic surgery. Methods A total of 80patients were divided into control group (n = 40 ) and treatment group(n = 40) by random number table method. Both groups of patients were given routine examination before surgery. All patients underwent ultrasound - guided unilateral serratus anterior plane block,0. 375%ropivacaine and anesthesia induction, maintenance and recovery.Treatment group was given parecoxibna before and 24 h after the operation, control group was given 0. 9% NaCl before general anesthesia. The mean arterial pressure (MAP ) ,heart rate (HR ) ,plasma cortisol (Cor) ,interleukin 6 (IL - 6) ,and tumor necrosis factorα (TNF - α) levels were compared between the two groups before and after surgery;visual analogue scale (VAS ) after surgery,bruggrmann comfort score (BCS) were compared between the two groups. Results MAP in treatment group and control group at T4 time of were (87. 56 ± 7. 53 ) ,(88. 95 ± 8. 36 ) mm Hg, HR were (87. 59 ± 8. 25 ) ,(89. 25 ± 8. 01 )beat·min^(-1),the differences were not statisitically significant (all P > 0. 05) . After treatment,the 24 h VAS in treatment group and control group were (2. 59 ± 0. 37) and (3. 01 ± 0. 36) points,the 24 h BCS were (2. 26 ± 0. 35)and (2. 12 ± 0. 25) points ,plasma Cor were (231. 58 ± 46. 96 ) and (252. 97 ± 46. 59 ) ng · mL^(-1),IL - 6 were(35. 58 ± 3. 01) and (39. 58 ± 2. 59) pg·mL^(-1),TNF - ɑ were (6. 39 ± 0. 72) and (10. 36 ± 0. 68) pg·mL^(-1),the differences were statistically significant (all P < 0. 05) . Conclusion 0. 375% ropivacaine combined with parecoxibna serratus anterior plane block can reduce postoperative pain,improve clinical symptoms,effectively control safety,and improve patient satisfaction in patients undergoing thoracoscopic surgery.