超声引导下前锯肌平面阻滞在老年周围型肺癌手术中的应用观察

Application of ultrasound-guided serratus anterior plane block in elderly patients with peripheral lung cancer

目的观察超声引导下前锯肌平面阻滞(SAPB)在老年周围型肺癌手术中的应用价值。方法将90例老年周围型肺癌患者随机分为观察组和对照组,每组45例。观察组在麻醉诱导后行超声引导下SAPB,对照组麻醉诱导后直接进行手术。采用视觉模拟评分法(VAS)比较患者的疼痛程度,简易精神状态检查量表(MMSE)评估患者的认知功能,同时比较两组患者的细胞免疫功能和不良反应。结果观察组患者术后2、4和12 h在静息和咳嗽时的VAS评分明显低于对照组,MMSE评分高于对照组(P<0.01)。术后24 h,两组的CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平均明显降低,观察组降低的幅度低于对照组(P<0.05或0.01)。观察组不良反应总发生率明显低于对照组(P<0.05)。结论超声引导下SAPB可减轻老年周围型肺癌手术患者的疼痛程度、术后认知功能障碍和细胞免疫功能损伤,同时可降低不良反应发生率。

Objective To investigate the application of ultrasound-guided serratus anterior plane block(SAPB)in elderly patients with peripheral lung cancer.Methods A total of 90 elderly patients with peripheral lung cancer were randomly divided into the Observation Group and the Control Group,45 cases in each group.The Observation Group received ultrasoundguided SAPB after anesthesia induction,while the Control Group underwent surgery directly after anesthesia induction.The pain intensity was compared with VAS and the cognitive function was evaluated with MMSE.The two groups were compared in terms of cellular immune function and adverse reactions.Results The VAS scores of the Observation Group during rest and cough at 2 h,4 h and 12 h after operation were significantly lower than those of the Control Group(P<0.01).The MMSE scores of the Observation Group at 2 h,4 h and 12 h were significantly higher than those of the Control Group(P<0.01).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)of the Observation Group at 24 h after operation were significantly higher than those of the Control Group(P<0.05).The total incidence of adverse reactions of the Observation Group was significantly lower than that of the Control Group(P<0.05).Conclusions Ultrasound-guided SAPB can reduce the pain intensity,postoperative cognitive dysfunction and cellular immune function impairment in elderly patients with peripheral lung cancer and decrease the incidence of adverse reactions.