超声引导下肋间神经阻滞联合全麻在老年原发性肺癌患者经胸腔镜根治术中的应用价值

Application of Ultrasound-guided Intercostal Nerve Block Combined with General Anesthesia in Elderly Patients with Primary Lung Cancer After Thoracoscopic Radical Resection

目的探讨超声引导下肋间神经阻滞联合全麻在老年原发性肺癌患者经胸腔镜根治术中的应用价值。方法选取行经胸腔镜根治术的老年原发性肺癌患者86例,依据麻醉方式分为观察组(n=46)和对照组(n=40),观察组行超声引导下肋间神经阻滞联合全麻,对照组行常规全麻。比较麻醉前与拔管后各生命体征指标变化,术后静息、活动各时间点疼痛视觉模拟(VAS)评分及术后各时间点Ramsay镇静评分。结果术后观察组2 h、6 h、12 h、24 h时间点VAS评分均明显较对照组低(P<0.05);术后观察组2 h、6 h、12 h、24 h时间点Ramsay镇静评分明显优于对照组(P<0.05);拔管后两组患者舒张压、收缩压、心率、血氧饱和度(SpO_(2))均明显较诱导前低(P<0.05),观察组舒张压、收缩压、心率明显较对照组低,SpO_(2)明显较对照组高(P<0.05)。结论超声引导下肋间神经阻滞联合全麻可明显改善经胸腔镜根治术后老年原发性肺癌患者的生命体征,缓解术后疼痛,具较好镇静作用,值得临床推广。

Objective To explore the application value of ultrasound-guided intercostal nerve block combined with general anesthesia in elderly patients with primary lung cancer after thoracoscopic radical resection.Methods A total of 86 elderly patients with primary lung cancer undergoing thoracoscopic radical resection in the hospital were enrolled.According to different anesthesia methods,they were divided into the observation group(n=46)and the control group(n=40).The observation group underwent ultrasound-guided intercostal nerve block combined with general anesthesia,while the control group underwent routine general anesthesia.The changes of vital signs before anesthesia and after extubation,scores of visual analogue scale(VAS)at rest and activity state,and scores of Ramsay sedation after surgery were compared between the 2 groups.Results At 2h,6h,12h and 24h after surgery,VAS scores in the observation group were significantly lower than those in the control group(P<0.05),and Ramsay sedation scores were significantly better than those in the control group(P<0.05).After extubation,diastolic blood pressure,systolic blood pressure,heart rate and blood oxygen saturation(SpO_(2))were significantly lower than those before induction in both groups(P<0.05).The diastolic blood pressure,systolic blood pressure and heart rate in the observation group were significantly lower than those in the control group,while SpO_(2) was significantly higher than that in the control group(P<0.05).Conclusion Ultrasound-guided intercostal nerve block combined with general anesthesia can significantly improve vital signs and relieve postoperative pain of elderly patients with primary lung cancer after thoracoscopic radical resection,with good sedative effect.