右美托咪定复合地塞米松肋间神经阻滞用于老年肺癌患者胸腔镜根治术后镇痛的效果分析

Analgesic effect of dexmedetomidine combined with dexamethasone for intercostal nerve block in elderly patients with lung cancer after thoracoscopic radical surgery

目的 分析右美托咪定复合地塞米松肋间神经阻滞在老年肺癌患者胸腔镜根治术后镇痛中的效果。方法 选取2020年12月—2023年6月在无锡市第五人民医院行胸腔镜根治术的82例老年肺癌患者,采用随机数字表法分为对照组和研究组,每组41例。对照组术毕给予地塞米松复合罗哌卡因肋间神经阻滞,研究组术毕给予右美托咪定复合地塞米松、罗哌卡因肋间神经阻滞。比较两组肋间神经阻滞及术后静脉自控镇痛(PCIA)用药情况,对比两组围手术期疼痛、认知功能、应激反应、炎症反应及麻醉相关药物不良反应情况。结果 研究组肋间神经阻滞镇痛持续时间长于对照组,术后48 h舒芬太尼消耗总量少于对照组(P <0.05)。研究组与对照组术后4、12、24和48 h的视觉模拟评分(VAS)评分比较,结果:(1)不同时间点VAS评分比较,差异有统计学意义(F=9.156,P=0.000);(2)研究组与对照组VAS评分比较,差异有统计学意义(F=7.851,P=0.000);(3)两组VAS评分变化趋势比较,差异有统计学意义(F=7.061,P=0.000)。研究组与对照组术前及术后24和48 h的简易精神状态检查(MMSE)量表评分比较,结果:(1)不同时间点MMSE评分比较,差异无统计学意义(F=0.179,P=0.834);(2)研究组与对照组MMSE评分比较,差异无统计学意义(F=0.151,P=0.859);(3)两组MMSE评分变化趋势比较,差异无统计学意义(F=0.309,P=0.724)。研究组与对照组术前及术后24、48 h的肾上腺素(Adr)、皮质醇(Cor)比较,结果:(1)不同时间点Adr、Cor比较,差异均有统计学意义(F=7.967和8.043,均P=0.000);(2)研究组与对照组Adr、Cor比较,差异均有统计学意义(F=7.123和7.691,均P=0.000);(3)两组Adr、Cor变化趋势比较,差异均有统计学意义(F=8.003和7.961,均P=0.000)。研究组与对照组开始麻醉及术后24和48 h的肿瘤坏死因子α(TNF-α、)高迁移率族蛋白B1(HMGB1)比较,结果:(1)不同时间点TNF-α、HMGB1比较,差异均有统计学意义(F=8.236和8.417,均P=0.000);(2)研究组与对照组TNF-α、HMGB1比较,差异均有统计学意义(F=6.298和7.215,均P=0.000);(3)两组TNF-α、HMGB1变化趋势比较,差异均有统计学意义(F=7.035和7.152,均P=0.000)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 右美托咪定复合地塞米松肋间神经阻滞用于老年肺癌患者胸腔镜根治术后镇痛可延长肋间神经阻滞时间,减少术后舒芬太尼消耗量,并可减轻术后疼痛、应激反应及炎症反应,且安全性良好。

Objective To analyze the analgesic effect of dexmedetomidine combined with dexamethasone for intercostal nerve block in elderly patients with lung cancer after thoracoscopic radical surgery.Methods Eighty-two elderly patients with lung cancer who underwent thoracoscopic radical surgery in our hospital from December 2020 to June 2023 were selected and divided into the control group and the study group by random number table method,with 41 cases in each group.The control group was given dexamethasone combined with ropivacaine,and the study group was given dexmedetomidine combined with dexamethasone and ropivacaine for intercostal nerve block after the operation.The effect of intercostal nerve block and use of patient-controlled intravenous analgesia(PCIA)were compared between the two groups.Besides,perioperative pain,cognitive function,stress response,inflammatory response and anesthesia-related adverse drug reactions were also compared between the two groups.Results The effective duration of analgesia via intercostal nerve block in the study group was longer than that in the control group,and the total consumption of sufentanil within 48 hours after the operation in the study group was lower than that in the control group(P<0.05).Comparison of Visual Analogue Scale(VAS)scores 4 h,12 h,24 h and 48 h after the surgery in the two groups showed that VAS scores were different among time points(F=9.156,P=0.000)and between the study group and the control group(F=7.851,P=0.000),where VAS scores 12 h and 24 h after the surgery in the study group were lower than those in the control group.The change trends of VAS scores were also different between the study group and the control group(F=7.061,P=0.000).Comparison of Mini-Mental State Examination(MMSE)scores before and 24 h and 48 h after the surgery in the two groups showed no difference in MMSE scores among time points(F=0.179,P=0.834)or between the two groups(F=0.151,P=0.859),and no difference in the change trends of MMSE scores between the two groups(F=0.309,P=0.724).Comparison of levels of adrenaline(Adr)and cortisol(Cor)before and 24 h and 48 h after the surgery in the two groups showed that levels of Adr and Cor were different among time points(F=7.967 and 8.043,both P=0.000)and between the two groups(F=7.123 and 7.691,both P=0.000),where levels of Adr and Cor 24 h and 48 h after the surgery in the study group were lower than those in the control group.Besides,the change trends of levels of Adr and Cor were different between the study group and the control group(F=8.003 and 7.961,both P=0.000).The levels of tumor necrosis factor-α(TNF-α)and high mobility group box 1(HMGB1)at the time of anesthesia and 24 h and 48 h after the surgery were compared between the two groups,which exhibited that they were different among time points(F=8.236 and 8.417,both P=0.000)and between the two groups(F=6.298 and 7.215,both P=0.000),where levels of TNF-αand HMGB124 h and 48 h after the surgery in the study group were lower than those in the control group.The change trends of levels of TNF-αand HMGB1 were different between the two groups(F=7.035 and 7.152,both P=0.000).There was no significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).Conclusions Dexmedetomidine combined with dexamethasone for intercostal nerve block can be applied for analgesia in elderly patients with lung cancer after thoracoscopic radical surgery.It prolongs the effective duration of analgesia via intercostal nerve block,reduces postoperative consumption of sufentanil,and alleviates the postoperative pain,stress response and inflammation with few safety concerns.