经皮神经电刺激联合胸椎旁神经阻滞对胸腔镜肺癌根治术术后疼痛和睡眠质量的影响

Effect of Transcutaneous Nerve Stimulation Combined with Thoracic Paravertebral Nerve Block on Pain and Sleep Quality after Thoracoscopic Radical Resection of Lung Cancer

目的探讨经皮神经电刺激联合胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后疼痛和睡眠质量的影响。方法选取2020年1月—2022年6月江苏省徐州市中医院收治的120例胸腔镜肺癌根治术患者,按照随机数表法将其分为对照组和试验组,各60例。对照组采取胸椎旁神经阻滞,试验组采取经皮神经电刺激联合胸椎旁神经阻滞。采用数字分级评分法(NRS)评估两组术后静息和活动性疼痛,记录术后补救镇痛发生情况,采用匹兹堡睡眠质量指数(PSQI)评估术后1 d、2 d、3 d的睡眠质量。结果两组术后4 h、8 h、12 h、72 h的静息NRS评分比较,差异无统计学意义(P>0.05),试验组术后24 h、48 h的静息NRS评分明显低于对照组,差异有统计学意义(P<0.05);两组术后4 h、8 h、12 h、24 h、48 h的活动性NRS评分比较,差异无统计学意义(P>0.05),试验组术后72 h的活动性NRS评分明显低于对照组,差异有统计学意义(P<0.05)。试验组术后2 d的补救镇痛率明显低于对照组,差异有统计学意义(P<0.05),两组术后1 d、3 d的补救镇痛率比较,差异无统计学意义(P>0.05)。试验组术后1 d、2 d的PSQI评分明显低于对照组,差异有统计学意义(P<0.05),两组术后3 d的PSQI评分比较,差异无统计学意义(P>0.05)。结论与单纯胸椎旁神经阻滞相比,联合经皮神经电刺激对活动性疼痛的改善有限,但可有效减轻静息性疼痛,减少补救镇痛情况的发生,并降低PSQI评分。

Objective To investigate the eff ect of transcutaneous nerve stimulation combined with thoracic paravertebral nerve block on pain and sleep quality after thoracoscopic radical resection of lung cancer.Methods From January 2020 to June 2022,120 patients with thoracoscopic radical resection of lung cancer were randomly divided into two groups,60 patients in each group.The control group was treated with thoracic paravertebral nerve block,and the experimental group was treated with transcutaneous nerve stimulation combined with thoracic paravertebral nerve block.NRS was used to evaluate the rest and active pain after operation in the two groups,and the occurrence of postoperative relief analgesia was recorded.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the sleep quality on the 1st,2nd and 3rd day after operation.Results The NRS score of resting pain at 24 h and 48 h after operation in the experimental group was signifi cantly lower than that in the control group(P<0.05),while the NRS score of resting pain at 4 h,8 h,12 h and 72 h after operation in the two groups was not statistically signifi cant(P>0.05).The NRS score of active pain in the two groups at 4 h,8 h,12 h,24 h and 48 h after operation was not statistically significant(P>0.05).The NRS score of active pain in the experimental group at 72 h after operation was signifi cantly lower than that in the control group(P<0.05).The rescue analgesia rate in the experimental group was signifi cantly lower than that in the control group(P<0.05),and there was no signifi cant diff erence in the rescue analgesia rate between the two groups on the fi rst and third day after operation(P>0.05).The PSQI scores of the experimental group on the 1st and 2nd day after operation were signifi cantly lower than those of the control group(P<0.05),and there was no statistically signifi cant diff erence between the two groups on the 3rd day after operation(P>0.05).Conclusion Compared with simple thoracic paravertebral nerve block,combined with percutaneous nerve electrical stimulation has limited improvement on active pain,but it can eff ectively relieve resting pain,reduce relief pain,and reduce PSQI score.