经胸膜外间隙导管注入局麻药对胸腔镜术后镇痛效果、并发症的影响

Effect of Local Anesthetic Injection via Extrapleural Space Catheter on Analgesic Effect and Complications after Thoracoscopic Surgery

目的探讨经胸膜外间隙导管注入局麻药镇痛对胸腔镜术后镇痛效果、并发症的影响。方法选取2020年3月-2022年4月收治的胸腔镜术后120例为研究对象,根据麻醉方式不同分为患者自控静脉镇痛(PCIA)组和导管组,每组60例。PCIA组采用PCIA,导管组采用经胸膜外间隙导管注入局麻药镇痛。比较2组术后视觉模拟评分法(VAS)评分、麻醉苏醒时间、首次自主翻身时间、首次自主坐起时间、下床活动时间、疼痛介质[5-羟色胺(5-HT)、β-内啡肽(β-EP)、P物质(SP)、神经肽Y(NPY)]、应激指标[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]、匹兹堡睡眠质量指数(PSQI)评分、补救镇痛率及并发症发生情况。结果导管组术后8、12、24、48、72 h VAS评分均低于PCIA组(P<0.01)。导管组首次自主翻身时间、首次自主坐起时间、下床活动时间均短于PCIA组(P<0.01)。术后24、72 h,导管组5-HT、SP、NPY、Cor、ACTH水平低于PCIA组(P<0.01),2组β-EP水平比较差异无统计学意义(P>0.05)。术后24、48、72 h,导管组PSQI评分低于PCIA组(P<0.05,P<0.01)。导管组补救镇痛率低于PCIA组(P<0.05);2组麻醉苏醒时间及并发症总发生率比较差异无统计学意义(P>0.05)。结论与PCIA相比,经胸膜外间隙导管注入局麻药对胸腔镜术后镇痛效果更为显著,应激反应降低效果更佳,术后睡眠质量、麻醉苏醒质量更优,且不会增加并发症发生风险。

Objective To investigate the effect of local anesthetic injection via extrapleural space catheter on the analgesic effect and complications after thoracoscopic surgery.Methods A total of 120 cases admitted after thoracoscopy from March 2020 to April 2022 were selected for the study,and divided into patient-controlled intravenous analgesia(PCIA)group(n=60)and catheter group according to different anesthesia methods(n=60).The PCIA group received PCIA,and the catheter group received local anesthetic injection via extrapleural space catheter.The visual analogue scale(VAS)scores,time to awaken from anesthesia,time to first voluntary turning,time to first voluntary sitting up,time of off-bed activity,pain mediators[5-hydroxytryptamine(5-HT),β-endorphin(β-EP),substance P(SP),neuropeptide Y(NPY)],stress indicators[cortisol(Cor),adrenocorticotropic hormone(ACTH)],Pittsburgh Sleep Quality Index(PSQI)scores,remedial analgesia rate and complications after surgery in the two groups were compared.Results The VAS scores at 8,12,24,48,and 72 h postoperatively were lower in the catheter group than in the PCIA group(P<0.01).The time to first voluntary turning,time to first voluntary sitting up and time of off-bed activity were shorter in the catheter group than in the PCIA group(P<0.01).At 24 and 72 h after surgery,the levels of 5-HT,SP,NPY,Cor,and ACTH in the catheter group were lower than those in the PCIA group(P<0.01),and the difference inβ-EP levels between the two groups was not statistically significant(P>0.05).At 24,48,and 72 h after surgery,the PSQI scores in the catheter group were lower than those in the PCIA group(P<0.05,P<0.01).The rate of remedial analgesia in the catheter group was lower than that in the PCIA group(P<0.05);there was no statistically significant difference between the two groups in terms of the time to awaken from anesthesia and the total incidence of complications(P>0.05).Conclusion Compared with PCIA,local anesthetic injection via extrapleural space catheter is more effective in post-thoracoscopic analgesia,with better stress reduction,better postoperative sleep quality,better quality of awakening from anesthesia,and no increased risk of complications.