超声引导下星状神经节在肺癌胸腔镜术患者中的应用效果及术后急性疼痛危险因素分析

Effect of Ultrasound-Guided Stellate Ganglion in Patients Undergoing Thoracoscopic Surgery for Lung Cancer and Risk Factors of Postoperative Acute Pain

目的:探讨超声引导下星状神经节阻滞(SGB)在肺癌胸腔镜术患者中的应用效果,并分析术后急性疼痛危险因素。方法:选取2021年1月至2022年12月在我院行肺癌胸腔镜术的患者98例,随机分为研究组和对照组各49例,研究组在超声引导下行C6~7水平右侧星状神经节阻滞,给予0.5%罗哌卡因5mL,对照组在相同位置给予生理盐水5mL,比较两组围术期相关指标,星状神经节阻滞前(T_(1))、拔管后5min(T_(2))、术后第1天早上6:00(T_(3))的应激反应指标。术后1d采用视觉模拟评分法(VAS)评估疼痛,按照VAS评分分为急性疼痛组(VAS≥3分)29例和非急性疼痛组(VAS<3分)69例,分析术后急性疼痛的危险因素。结果:研究组术后拔管时间、离开恢复室到SM的时间、舒芬太尼使用量、PAPT、术后谵妄率、恶心和呕吐率与对照组比较,均无统计学意义(P>0.05),研究组术后出院时间明显短于对照组(P<0.05)。在T_(2)、T_(3)时点两组肾上腺素(E)、去甲肾上腺素(NE)水平较T_(1)时点均升高(P<0.05),但研究组E、NE明显低于对照组(P<0.05)。经单因素分析,年龄、手术时间、肋间隙宽度、心理焦虑是肺癌胸腔镜术患者术后急性疼痛的影响因素(P<0.05),经多因素二元Logistic回归分析,手术时间≥150min、心理焦虑是肺癌胸腔镜术患者术后急性疼痛的危险因素,肋间隙宽度≥1cm是肺癌胸腔镜术患者术后急性疼痛的保护因素(P<0.05)。结论:超声引导下SGB应用于肺癌胸腔镜术患者,可有效减轻应激反应,缩短患者住院时间;术后疼痛与手术时间≥150min、肋间隙宽度<1cm、心理焦虑有关。

Objective:To investigate the effect of ultrasound-guided stellate ganglion block(SGB)in patients with thoracoscopy for lung cancer and analyze the risk factors for acute postoperative pain.Methods:A total of 98 patients undergoing thoracoscopic surgery for lung cancer in our hospital from January 2021 to December 2022 were randomly divided into 2 groups,49 cases in the control group and 49 cases in the study group.In the study group,a right stellate ganglion block was performed at the C6~7 level under ultrasound guidance,and 5mL of 0.5%ropivacaine was given,while in the control group,5 mL of saline was given at the same location to compare the two groups with perioperative indicators before stellate ganglion block(T_(1)),5 min(T_(2))after extubation,and 6:00 am(T_(3)).After one day,pain was assessed by visual analogue scoring method(VAS).According to the VAS score,29 patients were divided into the acute pain group(VAS 3 points)and 69 patients in the non-acute pain group(VAS<3 points).The risk factors for postoperative acute pain were analyzed.Results:Postoperative extubation time,time to leave the recovery room to SM,sufentanil use,PAPT,postoperative delirium rate,nausea and vomiting rate of the study group were not statistically significant compared with that of the control group(P>0.05),and the postoperative discharge time of the study group was significantly shorter than that of the control group(P<0.05).The levels of epinephrine(E)and norepinephrine(NE)were elevated in both groups at the T_(2) and T_(3 )time points compared with the T_(1) time point(P<0.05),but E and NE were significantly lower in the study group than in the control group(P<0.05).After univariate analysis,age,operation time,intercostal space width,and psychological anxiety were the influencing factors of postoperative acute pain in thoracoscopic patients with lung cancer(P<0.05),and after multifactorial binary logistic regression analysis,operation time≥150min and psychological anxiety were the risk factors of postoperative acute pain in thoracoscopic patients with lung cancer,and intercostal space width≥1cm was a postoperative protective factor for acute pain(P<0.05).Conclusion:Ultrasound-guided SGB applied to patients undergoing thoracoscopic surgery for lung cancer effectively reduces stress and shortens patients'hospitalization time;postoperative pain is associated with operative time≥150 min,intercostal space width<1 cm,and psychological anxiety.