连续竖脊肌平面阻滞对老年肺癌根治术后快速康复的影响

Effect of continuous erector spinae plane block on rapid recovery after radical resection of lung cancer in the elderly

目的探究连续竖脊肌平面阻滞(ESPB)对老年肺癌根治术后快速康复的影响。方法60例行肺癌根治术治疗的老年患者为研究对象,采用计算机随机软件将患者分为试验组与对照组,每组30例。试验组采用罗哌卡因连续竖脊肌平面阻滞联合静脉自控镇痛,对照组采用单纯静脉自控镇痛,不予神经阻滞。比较两组术后2、8、12、24、48 h静息和运动时疼痛情况,术前30 min,术后8、12、24、48 h的IL-6与IL-10水平,术中瑞芬太尼用量、术后48 h内静脉镇痛泵有效按压次数和舒芬太尼追加量,术后48 h恶心及呕吐发生率、肛门排气时间、首次下床时间、术后低氧血症发生率,术后24、48 h 15项恢复质量评分量表(QoR-15)评分与住院天数。结果术后2、8、12、24、48 h静息和运动时,试验组视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(P<0.05)。术后8、12、24、48 h,试验组IL-6水平均低于对照组,IL-10水平均高于对照组,差异有统计学意义(P<0.05)。试验组术中瑞芬太尼用量(1972.76±23.30)μg、术后48 h内静脉镇痛泵有效按压次数(0.4±1.2)次均少于对照组的(2031.52±30.16)μg、(2.3±1.6)次,差异有统计学意义(P<0.05)。试验组术后48 h恶心、呕吐发生率与低氧血症发生率分别为16.67%、10.00%、0,均低于对照组的40.00%、33.33%、13.33%,肛门排气时间(5.16±0.67)h与首次下床时间(17.74±1.68)h均短于对照组的(6.49±1.46)、(19.52±3.18)h,差异均有统计学意义(P<0.05)。术后24、48 h,试验组QoR-15评分(95.64±6.97)、(105.49±7.62)分均高于对照组的(90.66±3.99)、(98.16±5.59)分,住院天数(5.74±1.03)d短于对照组的(7.13±2.52)d,差异均有统计学意义(P<0.05)。结论在老年肺癌根治术患者中实施连续竖脊肌平面阻滞复合静脉自控镇痛可减轻患者术后疼痛,减轻围术期炎症反应,减少术中阿片类药物的使用量,减少术后相关并发症,术后恢复质量更高,有利于患者术后快速康复,让患者尽早下床、出院,缩短患者住院时间。

Objective To investigate the effect of continuous erector spinae plane block(ESPB)on rapid recovery after radical resection of lung cancer in the elderly.Methods A total of 60 patients after radical resection of lung cancer were selected as the research subjects.The patients were divided into experimental group and control group by computer random software,with 30 patients in each group.The experimental group was treated with ropivacaine continuous erector spinae plane block combined with patient-controlled intravenous analgesia,while the control group was treated with patient-controlled intravenous analgesia without nerve block.Both groups were compared in terms of pain at rest and during exercise at 2,8,12,24 and 48 h postoperatively,IL-6 and IL-10 levels at 30 min preoperatively,8,12,24 and 48 h postoperatively,intraoperative remifentanil dosage,effective pressing number of intravenous analgesia pump and additional sufentanil dosage at 48 h postoperatively,incidence of nausea and vomiting at 48 h postoperatively,anal exhaust time,time to first ambulation,incidence of postoperative hypoxemia,and Quality of Recovery-15 scale(QoR-15)scores at 24 and 48 h postoperatively,and the length of hospital stay.Results At 2,8,12,24 and 48 h postoperatively,the visual analogue scale(VAS)scores at rest and during exercise in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 8,12,24 and 48 h postoperatively,the IL-6 level of the experimental group was lower than that of the control group,and the IL-10 was higher than that of the control group,and the differences were statistically significant(P<0.05).In the experimental group,the intraoperative remifentanil dosage was(1972.76±23.30)μg and the effective pressing number of intravenous analgesia pump was(0.4±1.2)pressings,which were less than(2031.52±30.16)μg and(2.3±1.6)pressings in the control group,and the differences were statistically significant(P<0.05).The incidence of nausea,vomiting and hypoxemia in the experimental group at 48 h postoperatively were 16.67%,10.00%,and 0,which were lower than 40.00%,33.33%,and 13.33%in the control group;the anal exhaust time(5.16±0.67)h and the time to first ambulation(17.74±1.68)h in the experimental group were shorter than(6.49±1.46)and(19.52±3.18)h in the control group;the differences were all statistically significant(P<0.05).At 24 and 48 h postoperatively,the QoR-15 score of the experimental group were(95.64±6.97)and(105.49±7.62)points,which were higher than(90.66±3.99)and(98.16±5.59)points of the control group;the length of hospital stay(5.74±1.03)d of the experimental group was shorter than(7.13±2.52)d of the control group;the differences were statistically significant(P<0.05).Conclusion The implementation of continuous erector spinae plane block combined with patient-controlled intravenous analgesia in elderly patients after radical resection of lung cancer can reduce postoperative pain,reduce perioperative inflammatory reactions,reduce the dosage of intraoperative opioids,reduce postoperative-related complications,and improve the quality of postoperative recovery,which is conducive to rapid postoperative recovery,enabling patients to get out of bed and discharge as soon as possible,and shortening the length of hospital stay.