竖脊肌平面阻滞复合全身麻醉对老年患者胸腔镜肺叶切除术后镇痛效果

Effect of the Erector Spinae Plane Block Combined with General Anaesthesia on Analgesia after Thoracoscopic Lobectomy in Elderly Patients

目的:探究竖脊肌平面阻滞(ESPB)复合全身麻醉对老年胸腔镜肺叶切除术后镇痛效果。方法:选择2020年1月—2022年1月由北京航天总医院麻醉科实施麻醉的胸腔镜肺叶切除术患者200例,应用随机数字表法将其分为对照组(全身麻醉)及观察组(ESPB复合全身麻醉)各100例,对比两组麻醉诱导前(T_(1))、切皮后1 h(T_(2))、术毕(T_(3))、术后4 h(T_(4))、术后12 h(T_(5))、术后24 h(T_(6))、术后48 h(T_(7))的心率(HR)、平均动脉压(MAP);T_(4)、T_(6)、T_(7)的视觉模拟评分法(VAS)评分;T_(1)、T_(2)、T_(4)、T_(6)的白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ);T_(1)、T_(3)、T_(5)、T_(6)、T_(7)的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+);麻醉药物用量。结果:两组T_(1)、T_(6)、T_(7)的HR、MAP相较差异均无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)、T_(5)的HR、MAP均低于对照组,差异均有统计学意义(P<0.05)。观察组T_(4)、T_(6)、T_(7)的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组T_(1)的IL-6、IL-10、Cor、Ang-Ⅱ水平差异均无统计学意义(P>0.05);观察组T_(2)、T_(4)、T_(6)的IL-6、Cor、Ang-Ⅱ水平均低于对照组,IL-10均高于对照组,差异均有统计学意义(P<0.05)。两组T_(1)的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平差异均无统计学意义(P>0.05);两组T_(3)、T_(5)、T_(6)、T_(7)的上述指标均降低,观察组T_(6)、T_(7)的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组,T_(7)的CD8^(+)高于对照组,差异均有统计学意义(P<0.05)。观察组术中丙泊酚、瑞芬太尼用量、术后24 h镇痛泵舒芬太尼用量均少于对照组,差异均有统计学意义(P<0.05)。结论:ESPB复合全身麻醉可为胸腔镜肺叶切除术患者提供良好术后镇痛,并减轻术后炎症反应,对T细胞亚群影响较小。

Objective:To investigate the analgesic effect of erector spinae plane block(ESPB)composite general anaesthesia on elderly patients after thoracoscopic lobectomy.Method:A total of 200 patients undergoing thoracoscopic lobectomy under anesthesia at the Anesthesia Department of Beijing Aerospace General Hospital from January 2020 to January 2022 were selected,and were divided into 100 cases each in the control group(general anaesthesia)and the observation group(ESPB composite general anaesthesia)by applying the method of random number table.Heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups before anesthesia induction(T_(1)),1 h after skin incision(T_(2)),the end of operation(T_(3)),4 h after operation(T_(4)),12 h after operation(T_(5)),24 h after operation(T_(6)),48 h after operation(T_(7));visual analogue scale(VAS)scores at T_(4),T_(6) and T_(7);interleukin-6(IL-6),interleukin-10(IL-10),cortisol(Cor),angiotensinⅡ(Ang-Ⅱ)at T_(1),T_(2),T_(4),T_(6);CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)at T_(1),T_(3),T_(5),T_(6),T_(7);dosage of narcotic drugs.Result:The differences between HR and MAP at T_(1),T_(6) and T_(7) were not significant(P>0.05);HR and MAP at T_(2),T_(3),T_(4),T_(5) in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).VAS scores of the observation group were lower than those of the control group at T_(4),T_(6) and T_(7),the differences were statistically significant(P<0.05).The differences in the levels of IL-6,IL-10,Cor,and Ang-Ⅱbetween the two groups at T_(1) were not significant(P>0.05);the levels of IL-6,Cor,and Ang-Ⅱof the observation group at T_(2),T_(4),and T_(6) were lower than those of the control group,and the levels of IL-10 were higher than those of the control group,the differences were statistically significant(P<0.05).The differences between CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the two groups at T_(1) were not significant(P>0.05);at T_(3),T_(5),T_(6),T_(7),the levels of the above indicators in the two groups were reduced,and at T_(6),T_(7),the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the observation group were higher than that of the control group,and at T_(7),the levels of CD8^(+)was higher than that of the control group,the differences were statistically significant(P<0.05).The dosage of intraoperative Propofol and Remifentanil and the dosage of postoperative 24 h analgesic pump Sufentanil in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).Conclusion:ESPB combined with general anaesthesia can provide good postoperative analgesia for patients undergoing thoracoscopic lobectomy and reduce postoperative inflammatory response with less effect on T-cell subpopulation.