肋间神经阻滞联合全身麻醉对肺癌胸腔镜手术患者呼吸循环指标、疼痛、认知功能的影响及其安全性

The effects and safety of intercostal nerve block combined with general anesthesia on respiratory and circulatory indicators,pain,and cognitive function in patients undergoing thoracoscopic surgery for lung cancer

目的探究肋间神经阻滞联合全身麻醉对肺癌胸腔镜手术患者呼吸循环指标、疼痛、认知功能的影响及其安全性。方法选取2019年3月至2020年3月于本院实施肺癌胸腔镜手术的72例患者作为研究对象,按照麻醉方式不同分为单一组(给予全身麻醉)和联合组(给予肋间神经阻滞联合全身麻醉),每组36例。比较两组麻醉前、麻醉后1 h的呼吸循环指标[心率(HR)、血氧饱和度(SpO_(2))、呼吸频率(RR)]、拔管后的Richmond躁动镇静量表(RASS)评分和自主呼吸恢复时间、术后6 h的视觉模拟评分法(VAS)和简易精神状态评价量表(MMSE)评分、并发症(躁动、喉痉挛、恶心呕吐、嗜睡)发生情况。结果麻醉后1 h,联合组HR、RR均低于单一组(P<0.05);两组SpO_(2)水平比较差异无统计学意义。联合组RASS评分、VAS评分均低于单一组,MMSE评分高于单一组,自主呼吸恢复时间短于单一组(P<0.05)。联合组并发症发生率为2.78%,低于单一组的22.22%(P<0.05)。结论在肺癌胸腔镜手术中采用肋间神经阻滞结合全身麻醉的方式,能有效改善患者呼吸循环系统,减轻疼痛,减少并发症发生,且对患者的认知功能影响较小,值得临床推广应用。

Objective To investigate the effects and safety of intercostal nerve block combined with general anesthesia on respiratory and circulatory indicators,pain,and cognitive function in patients undergoing thoracoscopic surgery for lung cancer.Methods 72 patients who underwent thoracoscopic surgery for lung cancer in our hospital from March 2019 to March 2020 were selected as research subjects,and they were divided into single group(given general anesthesia)and combined group(given intercostal nerve block combined with general anesthesia)according to different anesthesia methods,with 36 cases in each group.The respiratory and circulatory indexes(heart rate[HR],oxygen saturation[SpO_(2)],respiratory rate[RR])before and 1 h after anesthesia,the richmond agitation and sedation scale(RASS)score and the recovery time of spontaneous breathing after extubation,the visual analogue scale(VAS)and the mini-mental state examination(MMSE)score 6 h after surgery,and complications(restlessness,laryngeal spasm,nausea and vomiting,lethargy)were compared between two groups.Results After 1 h of anesthesia,HR and RR in the combined group were lower than those in the single group(P<0.05);there was no statistically significant difference in SpO_(2) levels between the two groups.The RASS score and VAS score in the combined group were lower than those in the single group,while the MMSE score was higher than that in the single group,the recovery time of spontaneous respiration was shorter than that in the single group(P<0.05).The incidence of complications in the combined group was 2.78%,which was lower than the 22.22%in the single group(P<0.05).Conclusion The use of intercostal nerve block combined with general anesthesia in thoracoscopic surgery for lung cancer can effectively improve the patient's respiratory and circulatory system,reduce pain,reduce the complications,and have small impact on the patient's cognitive function,it is worthy of clinical promotion and application.