静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果分析

Effect Analysis of Anterior Serserus Plane Block and Intercostal Nerve Block Under Intravenous General Anesthesia Combined with Ultrasound Guidance in Thoracoscopic Cuneform Resection of Lung

目的:探讨静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果。方法:选择2021年10月至2022年12月来我院诊治的60例行胸腔镜肺楔形切除术患者,根据随机数字表法,将60例患者分为对照组(30例)与观察组(30例),对照组30例患者行全麻联合胸椎旁阻滞+肋间神经阻滞的麻醉方法,观察组30例患者行全麻联合前锯肌+肋间神经阻滞的麻醉方法。对比两组患者监测入室时(T0)、插管即刻(T1)、手术切皮时(T2)、拔管即刻(T3)时的平均动脉压及心率,对比两组患者术后2 h、4 h、12 h、24 h、48 h的静息、咳嗽状态下的疼痛评分,对比两组患者T0-T3点的应激反应指标,对比两组患者术中血管活性药的使用剂量,对比两组患者围术期的不良反应发生率。结果:与T0点相比,观察组在T1、T2、T3时的平均动脉压、心率均有明显增加(P<0.05),而在T1点时,两组比较无差异(P>0.05);T2、T3点时观察组的平均动脉压、心率明显较对照组低(P<0.05)。随着术后时间延长,两组静息、咳嗽状态下的疼痛评分明显降低(P<0.05),而同时间点组间对比无统计学意义(P>0.05)。与T0点相比,观察组在T1、T2、T3时的肿瘤坏死因子、白介素6、白介素10水平均有明显增加(P<0.05),而同时间点观察组与对照组对比无统计学意义(P>0.05)。观察组术中血管活性药的使用剂量明显较对照组低(P<0.05)。观察组的不良反应发生率16.77%低于对照组23.33%,但组间对比无统计学意义(P>0.05)。结论:行静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞的胸腔镜肺楔形切除术者血流动力学更加稳定,术中所需血管活性药物用量明显降低。

Objective:To investigate the effect of anterior serserus plane and intercostal nerve block under intravenous anesthesia combined with ultrasound guidance in thoracoscopic cuneform resection of lung.Methods:60 patients with thoracoscopic wedge-shaped pulmonary resection admitted to our hospital from October 2021 to December 2022 were selected and divided into control group(30 cases)and observation group(30 cases)according to random number table method.30 patients in the control group received general anesthesia combined with thoracic paravertebral block+intercostal nerve block,and 30 patients in the observation group received general anesthesia combined with serratus anterior+intercostal nerve block.The mean arterial pressure and heart rate of the two groups were compared at the time of monitoring home invasion(T0),immediately after intubation(T1),at the time of operation sectioning(T2)and immediately after extubation(T3),the pain scores at resting and coughing at 2 h,4 h,12 h,24 h and 48 h after surgery,and the stress response indexes at T0-T3 points were compared between the two groups.The intraoperative dose of vasoactive drugs was compared between the two groups,and the incidence of perioperative adverse reactions was compared between the two groups.Results:Compared with T0,the mean arterial pressure and heart rate at T1,T2 and T3 increased significantly(P<0.05),while there was no difference between the two groups at T1(P>0.05);the mean arterial pressure and heart rate in the observation group at T2 and T3 were significantly lower than those of the control group(P<0.05).With the extension of postoperative time,the pain scores in resting and coughing state of the two groups were significantly decreased(P<0.05),but there was no statistical significance between the two groups at the same time point(P>0.05).Compared with T0 point,tumor necrosis factor,interleukin 6 and interleukin 10 levels in the observation group were significantly increased at T1,T2 and T3(P<0.05),but there was no statistical significance between the observation group and control group at the same time point(P>0.05).The dose of vasoactive drugs used in the observation group was significantly lower than that in the control group(P<0.05).The incidence of adverse reactions in observation group was 16.77%lower than that in control group(23.33%),but there was no statistical significance between groups(P>0.05).Conclusion:The hemodynamics of thoracoscopic wedge resection patients who underwent intravenous general anesthesia combined with ultrasound-guided anterior serration plane+intercostal nerve block were more stable,and the amount of vasoactive drugs required during the operation was significantly reduced.