胸椎旁神经阻滞对胸腔镜下肺部分切除术老年病人术后肺部并发症的影响

Effects of thoracic paravertebral block on postoperative pulmonary complications in elderly patients undergoing thoracoscopic partial lung resection

目的 基于倾向性评分匹配法探讨胸椎旁神经阻滞(TPVB)对胸腔镜下行肺部分切除术老年病人术后肺部并发症(PPCs)的影响。方法 回顾性分析本院2021年10月至2022年6月行胸腔镜下肺部分切除术老年病人818例,收集病人一般资料、围术期指标、影像学检查及实验室检验结果等,根据术前是否行TPVB将病人分为TPVB组和非TPVB组,应用倾向性评分匹配分析2组病人PPCs的发生情况。结果 通过倾向性评分匹配法,186例TPVB组病人与186例非TPVB组病人配对成功,2组基线资料比较,差异无统计学意义(P>0.05)。与非TPVB组比较,TPVB组病人术中阿片类镇痛药用量、PPCs发生率、术后补救性镇痛比例以及D-二聚体水平均较低(P<0.05)。结论 术前行TPVB可为胸腔镜下肺部分切除术老年病人提供良好的镇痛效果,可降低PPCs发生。

Objective To explore the effects of thoracic paravertebral block(TPVB)on postoperative pulmonary complications(PPCs)in the elderly patients undergoing thoracoscopic partial lung resection based on propensity score matching method.Methods A retrospective analysis of 818 elderly patients who underwent thoracoscopic partial lung resection from October 2021 to June 2022 was conducted.The patients were divided into TPVB group and non-TPVB group according to whether TPVB was performed preoperatively.The general data,perioperative variables,imaging detection and laboratory results of the patients were collected.After propensity score matching,the incidence of PPCs was compared between the two groups.Results After propensity score matching,there were 186 patients in each group.There were no significant differences in the baseline clinical data between the two groups(P>0.05).Compared with non-TPVB group,consumption of intraoperative opioids,the incidence rate of PPCs,proportion of rescue analgesia postoperatively and D-dimer level were significantly lower in the TPVB group(P<0.05).Conclusions Preoperative TPVB can provide effective analgesic effects and reduce the incidence of PPCs in the elderly patients undergoing thoracoscopic partial lung resection.