胸椎旁神经阻滞联合舒芬太尼多模式镇痛对胸腔镜肺癌根治术患者术后镇痛及安全性分析

Postoperative Analgesia Effect and Safety Analysis of Thoracic Paravertebral Nerve Block Combined with Sufentanil Multimodal Analgesia in Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

目的:探讨胸椎旁神经阻滞(TPVB)联合舒芬太尼多模式镇痛对胸腔镜肺癌根治术患者镇痛效果及安全性的影响。方法:纳入江南大学附属医院2020年6月-2022年6月收治的胸腔镜肺癌根治术患者104例,按随机数字表法分为TPVB组与对照组,各52例。对照组采用舒芬太尼多模式镇痛,TPVB组采用TPVB联合舒芬太尼多模式镇痛。比较两组术后2、6、12、24 h的Ramsay镇静评分与静息、咳嗽状态下的视觉模拟疼痛评分(VAS),分别在术前及术后24 h检测两组血清肾上腺素(E)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)、超氧化物歧化酶(SOD)水平及血管内皮生长因子(VEGF)、转化生长因子-β_(1)(TGF-β_(1))、肿瘤坏死因子-α(TNF-α)、S-100钙结合蛋白β(S-100β)水平,记录两组不良反应情况。结果:两组Ramsay镇静评分不存在时点、组间、交互效应(P>0.05)。两组静息与咳嗽状态下VAS评分存在时点、组间、交互效应(P<0.05);两组术后6、12、24 h VAS评分均低于术后2 h,且随着术后时间延长,VAS评分越低(P<0.05);TPVB组术后2、6、12、24 h VAS评分均低于对照组(P<0.05)。术后24 h,两组血清E、AngⅡ、NE水平均高于术前,SOD水平均低于术前,TPVB组均优于对照组(P<0.05)。术后24 h,两组血清VEGF、TGF-β_(1)、TNF-α、S-100β水平均高于术前,但TPVB组均低于对照组(P<0.05)。TPVB组不良反应发生率为17.31%,与对照组的7.69%比较,差异无统计学意义(P>0.05)。结论:TPVB联合舒芬太尼多模式镇痛能进一步缓解胸腔镜肺癌根治术患者的疼痛,提升镇痛效果,减轻术后应激,并能减少术后血清VEGF、TGF-β_(1)、TNF-α、S-100β水平的增高,可能对降低癌细胞侵袭、转移风险有益,安全性高。

Objective:To investigate the analgesic effect and safety of thoracic paravertebral nerve block(TPVB)combined with Sufentanil multimodal analgesia in patients undergoing thoracoscopic radical resection of lung cancer.Method:A total of 104 patients with thoracoscopic radical resection of lung cancer who admitted to Affiliated Hospital of Jiangnan University from June 2020 to June2022 were enrolled.According to the random number table method,they were divided into TPVB group and control group,52 cases in each group.The control group was given Sufentanil multimode analgesia,and TPVB group was given TPVB combined with Sufentanil multimode analgesia.The Ramsay sedation score at 2,6,12,24 h after operation and visual analogue pain scale(VAS)at rest and cough were compared between two groups.The serum levels of epinephrine(E),angiotensinⅡ(AngⅡ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β_(1)(TGF-β_(1)),tumor necrosis factor-α(TNF-α)and S-100 calcium binding proteinβ(S-100β)between two groups were detected before operation and 24 h after operation,and the adverse reactions of two groups were recorded.Result:There were no time point,intergroup and interaction effect on Ramsay sedation score between two groups(P>0.05).There were time point,inter group and interaction effects in VAS scores of two groups under resting and coughing conditions(P<0.05);the VAS scores at 6,12 and 24 h after surgery of two groups were lower than those at 2 h after surgery,and the VAS scores were lower with the extension of postoperative time(P<0.05);the VAS scores in TPVB group at 2,6,12 and 24 h after surgery were lower than those in the control group(P<0.05).At 24 h after surgery,the levels of serum E,AngⅡand NE in two groups were higher than those before surgery,and the levels of SOD in two groups were lower than those before surgery,and those in TPVB group were better than those in the control group(P<0.05).At 24 h after surgery,the levels of serum VEGF,TGF-β_(1),TNF-αand S-100βin two groups were higher than those before surgery,but those in TPVB group were lower than those in the control group(P<0.05).The adverse reaction rate of TPVB group was 17.31%,compared with 7.69%of the control group,there was no significant difference(P>0.05).Conclusion:TPVB combined with Sufentanil multimodal analgesia can further relieve the pain of patients undergoing thoracoscopic radical resection of lung cancer,improve the analgesic effect,reduce the postoperative stress,and reduce the increase of serum VEGF and TGF-β_(1),TNF-α,S-100βlevels,which may be beneficial to reduce the risk of cancer cell invasion and metastasis,and has high safety.