术中肋间神经阻滞对肋骨骨折患者机体应激反应、血流动力学及术后生活质量的影响

Effects of Intraoperative Intercostal Nerve Block on Body Stress Response,Hemodynamics and Postoperative Quality of Life in Patients with Rib Fracture

目的:前瞻性研究术中肋间神经阻滞(IINB)对肋骨骨折(RF)患者机体应激反应、血流动力学及生活质量的影响。方法:选择2017年1月-2021年12月于成都医学院第一附属医院行胸腔镜手术治疗的RF患者70例,依据随机数字表法分为IINB组(n=35)与对照组(n=35)。对照组行静吸复合全麻,IINB组于对照组基础上行IINB。观察两组手术前(T0),手术开始5 min(T1)、15 min(T2)、30 min(T3)及手术结束时(T4)平均动脉压(MAP)、心率(HR)等血流动力学指标;术后恢复情况;术后6h、12h、24h、48 h疼痛情况及镇痛补救率;术后1 d、3d、7d生存质量;术后3d并发症等指标。结果:IINB组各时点MAP、HR均低于对照组(P<0.05)。IINB组进食恢复时间、首次下床活动时间、留置胸管时间、术后住院时间均短于对照组(P<0.05)。IINB组术后6h、12h、24 h、48 h VAS评分均低于对照组(P<0.05);IINB组镇痛补救率20.00%(7/35)低于对照组42.86%(15/35)(P<0.05)。IINB组术后1 d、3 d、7 d各项生存质量评分均高于对照组(P<0.05)。IINB组术后3 d并发症发生率2.86%(1/35)低于对照组22.86%(8/35)(P<0.05)。结论:IINB可有效缓解RF患者疼痛及机体应激反应,维持术中血流动力学的稳定性,有效缓解术后疼痛,促进患者术后恢复,提高其生活质量,减少术后并发症。

Objective:A prospective study of the effect of intraoperative intercostal nerve block(IINB)on body stress response,hemodynamics and quality of life in patients with rib fracture(RF).Methods:70 RF patients who underwent thoracoscopic surgery in the First Affiliated Hospital of Chengdu Medical College from January 2017 to December 2021 were selected and divided into IINB group(n=35)and control group(n=35)according to the random number table.The control group was given intravenous and inhalation combined general anesthesia,and the IINB group was given IINB on the basis of the control group.The hemodynamic indexes such as mean arterial pressure(MAP)and heart rate(HR)before operation(T0),5 min(T1),15 min(T2),30 min(T3)and at the end of operation(T4);Postoperative recovery;Pain at 6 h,12 h,24 h and 48 h after operation and pain relief rate;Quality of life at 1 d,3 d and 7 d after operation;Postoperative complications and other indicators were observed.Results:MAP and HR of IINB group were lower than those of control group at all time points(P<0.05).The feeding recovery time,first time to get out of bed,time of indwelling chest tube and the postoperative hospitalization time in IINB group were shorter than those in the control group(P<0.05).The VAS score of IINB group was lower than that of control group at 6 h,12 h,24 h and 48 h after operation(P<0.05);The pain relief rate of IINB group was 20.00%(7/35)lower than that of control group 42.86%(15/35)(P<0.05).The quality of life scores in IINB group were higher than those in the control group on the 1 d,3 d and 7 d after operation(P<0.05).The incidence of complications in IINB group was 2.86%(1/35)lower than that 22.86%(8/35)in control group(P<0.05).Conclusion:IINB can effectively relieve the pain and body stress response of RF patients,maintain the stability of hemodynamics during operation,effectively relieve postoperative pain,promote postoperative recovery,improve their quality of life and reduce postoperative complications.