前锯肌平面阻滞复合全身麻醉对胸腔镜肺叶切除术患者镇痛效果、炎症细胞因子和早期恢复的影响

Effect of serratus anterior plane block combined with general anesthesia on analgesia, inflammatory cytokines and early recovery in patients undergoing thoracoscopic lobectomy

目的:探讨前锯肌平面阻滞(serratus anterior plane block,SAPB)复合全身麻醉对胸腔镜肺叶切除术患者镇痛效果、炎症细胞因子和早期恢复的影响。方法:选取胸腔镜肺叶切除术的患者240例,随机分为对照组(n=120)与SAPB组(n=120);SAPB组于麻醉诱导前行超声引导下SAPB(0.375%罗哌卡因20 mL),两组均予以瑞芬太尼、丙泊酚维持麻醉,术后均予以自控静脉镇痛。记录两组术后6、12、24h和24h静息时和咳嗽状态下的VAS评分、围手术期阿片类药物用量、补救镇痛率、术后恢复情况,检测两组手术前后血清白细胞介素-6(interleukin-6,IL-6)、IL-1β、肿瘤坏死因子α(tumor necrosisfactor-α,TNF-α)水平,并统计两组不良反应。结果:与对照组相比,SAPB组术后24h内静息和咳嗽状态下的VAS评分显著降低(P<0.05),术中瑞芬太尼用量、术后舒芬太尼用量和补救镇痛率显著降低(P<0.05),且气管拔管、下床活动、肛门排气和术后住院时间均明显提前(均P<0.05),胸腔闭式引流管留置时间缩短(P<0.05)。术后24 h,两组IL-6、IL-1β、TNF-α水平较术前均增高(均P<0.05);与对照组相比,SAPB组IL-6、IL-1β、TNF-α水平较低(P<0.05)。SAPB组恶心呕吐、皮肤瘙痒发生率显著低于对照组(P<0.05)。结论:SAPB复合全身麻醉可提高胸腔镜肺叶切除术患者术后镇痛效果,抑制炎症应激反应,促进术后早期恢复。

Objective: To investigate the effect of serratus anterior plane block(SAPB) combined with general anesthesia on analgesic effect, inflammatory cytokines and early recovery in patients undergoing thoracoscopic lobectomy. Methods: A total of 240 patients undergoing thoracoscopic lobectomy were selected and randomly divided into control group(n=120) and SAPB group(n=120). SAPB group received ultrasound-guided SAPB(0.375% ropivacaine 20 mL) before induction of anesthesia. Both groups were given remifentanil and propofol to maintain anesthesia, and postoperative patient-controlled intravenous analgesia was given. The VAS scores, perioperative opioid dosage, remedial analgesia rate and postoperative recovery at 6, 12, and 24 h a?ter operation, and 24 h at rest and under coughing state were recorded in the 2 groups. The levels of serum interleukin-6(IL-6), IL-1β and tumor necrosis factor-α(TNF-α) before and after operation were detected in the 2 groups, and the adverse reactions were statistically analyzed. Results: Compared with the control group, the VAS scores at rest and cough within 24 h a?ter operation in the SAPB group were significantly decreased(P<0.05), and the intraoperative remifentanil dosage, postoperative sufentanil dosage and remedial analgesia rate were significantly decreased(P<0.05). The extubation, ambulation, anal exhaust and postoperative hospital stay were significantly advanced in the SAPB group(P<0.05), the indwelling time of closed thoracic drainage tube was significantly shortened(P<0.05). At 24 h a?ter operation, the levels of IL-6, IL-1β and TNF-α in the 2 groups were higher than those before operation(all P<0.05). Compared with the control group, the levels of IL-6, IL-1β and TNF-α in SAPB group were lower(P<0.05). The incidence of nausea, vomiting and pruritus in SAPB group was significantly lower than that in the control group(P<0.05). Conclusion: SAPB combined with general anesthesia can improve the postoperative analgesic effect of thoracoscopic lobectomy, inhibit inflammatory stress response and promote early postoperative recovery.