超声引导胸椎旁神经阻滞对肺癌根治术患者术后感染的影响

Impact of ultrasound-guided thoracic paravertebral nerve block on postoperative infection in lung cancer patients undergoing radical surgery

目的 分析超声引导胸椎旁神经阻滞对肺癌根治术患者术后感染的影响。方法 选择2019年1月-2021年5月于邯郸市中心医院进行肺癌根治术治疗患者,其中109例采用超声引导下胸椎旁阻滞镇痛(椎旁阻滞组),109例采用静脉自控镇痛(静脉镇痛组)。分析两组术后感染患者病原菌分布,分析两组患者不同状态下麻醉诱导前(T1)、术后1 h(T2)、术后6 h(T3)、术后24 h(T4)、术后48 h(T5)视觉模拟疼痛评分(VAS)和心率(HR)、平均动脉压(MAP)及血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平;统计两组术后并发症。结果 椎旁阻滞组共18例术后感染,感染率为16.51%,静脉镇痛组共29例术后感染,感染率为26.61%,两组术后感染率比较有统计学差异(χ^(2)=13.956,P=0.004)。感染患者主要检出病原菌为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌。静息状态下T2-T4时刻椎旁阻滞组的VAS评分均低于静脉镇痛组,咳嗽咳痰状态下T2-T5时刻椎旁阻滞组VAS评分均低于静脉镇痛组(P<0.05),T2-T5时刻椎旁阻滞组血清IL-6、TNF-α水平均低于静脉镇痛组;T3-T5时刻椎旁阻滞组的HR水平均低于静脉镇痛组(P<0.05),两组术后恶心呕吐、头晕、低血压、低氧血症、肺不张的发生率差异无统计学意义。结论 超声引导胸椎旁神经阻滞能够降低肺癌根治术患者术后感染率,缓解术后疼痛,稳定血清炎性反应,稳定心率。

OBJECTIVE To observe the impact of ultrasound-guided thoracic paravertebral nerve block on postoperative infection in lung cancer patients undergoing radical surgery. METHODS The patients who underwent lung cancer radical surgery in Handan Central Hospital from Jan 2019 to May 2021 were enrolled in the study, 109 patients who were treated with ultrasonic-guided thoracic paravertebral block and analgesia were assigned as the paravertebral block group, and 109 patients who were treated with intravenous controlled analgesia were assigned as the intravenous analgesia group. The distribution of pathogens isolated from the two groups of patients with postoperative infection was analyzed. The visual analogue scale(VAS), heart rate(HR) and mean arterial pressure(MAP) as well as levels of serum inflammatory factors [interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)] were observed and compared between the two groups of patients at T1(before anesthesia induction), T2(after surgery for 1 hour), T3(after surgery for 6 hours), T4(after surgery for 24 hours) and T5(after surgery for 48 hours). The postoperative complications were statistically analyzed. RESULTS Totally 18 patients had postoperative infection in the paravertebral block group, with the infection rate 16.51%;totally 29 patients had postoperative infection in the intravenous analgesia group, with the infection rate 26.61%, and there was significant difference in the incidence of postoperative infection between the two groups(χ^(2)=13.956,P=0.004). Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were dominant among the pathogens isolated from the patients. The VAS scores of the paravertebral block group were significantly lower thanthose of the intravenous analgesia group at T2-T4 under quiescent condition, the VAS scores of the paravertebral block group were significantly lower thanthose of the intravenous analgesia group at T2-T5 under condition of cough and expectoration(P<0.05). The levels of serum IL-6 and TNF-α of the paravertebral block group were significantly lower thanthose of the intravenous analgesia group at T2-T5, while the HRs of the paravertebral block group were significantly lower thanthose of the intravenous analgesia group at T3-T5(P<0.05). There were no significant differences in the incidence rates of postoperative nausea and vomiting, dizziness, hypotension, hypoxemia and atelectasis between the two groups. CONCLUSION The ultrasound-guided thoracic paravertebral nerve block can reduce the incidence of postoperative infection in the lung cancer patients undergoing radical surgery, relieve postoperative pain and stabilize serum inflammatory response as well as heart rate.