胸腔镜直视下肋间神经阻滞联合纳布啡用于胸腔镜肺段切除术后多模式镇痛

Application of thoracoscope assisted intercostal nerve block combined with nalbuphine for postoperative multimodal analgesia in lung segment resection surgery

目的评价胸腔镜直视下肋间神经阻滞联合纳布啡多模式镇痛在胸腔镜肺段切除术的效果。方法2022年4月~2022年9月择期行胸腔镜下肺段切除术病人60例,按照随机数字表法分为两组,每组各30例。观察组在关闭胸腔之前行胸腔镜直视下肋间神经阻滞,术后镇痛泵采用纳布啡联合舒芬太尼静脉自控镇痛(PCIA);对照组直接关闭胸腔,术后镇痛泵采用舒芬太尼静脉自控镇痛。两组病人均在全身麻醉下完成手术。记录术后2小时、4小时、8小时、24小时和48小时视觉模拟疼痛评分(VAS)、PCIA有效按压次数、补救镇痛情况和相关不良反应发生情况。结果观察组术后2小时、4小时、8小时、24小时和48小时静息时VAS评分分别为(1.8±0.8)分、(1.9±0.8)分、(2.1±0.9)分、(2.3±0.9)分、(2.1±0.8)分,对照组分别为(3.3±1.1)分、(3.5±1.0)分、(2.8±0.9)分、(2.7±0.7)分和(2.6±0.8),两组比较差异有统计学意义(P<0.05);观察组术后2小时、4小时和8小时活动时VAS评分分别为(2.2±0.6)分、(2.3±0.6)分、(2.5±0.9)分,对照组分别为(3.9±1.9)分、(3.9±1.7)分、(3.3±1.7)分,两组比较差异有统计学意义(P<0.05)。观察组病人在术后24小时内及48小时内PCIA有效按压次数分别为(2.7±1.5)次和(5.4±2.3)次,对照组分别为(5.2±3.4)次和(10.2±6.0)次,两组比较差异有统计学意义(P<0.05)。观察组病人术后镇痛补救例数少于对照组(P<0.05)。两组不良反应发生率比较无明显差异(P>0.05)。观察组病人满意率高于对照组,差异有统计学意义(P<0.05)。结论胸腔镜直视下肋间神经阻滞联合纳布啡多模式镇痛方式可作为胸腔镜肺段切除术后镇痛的一种选择。

Objective To evaluate the effect of thoracoscope assisted intercostal nerve block combined with nalbuphine for postoperative multimodal analgesia after lung segment resection surgery.Methods From April 2022 to September 2022,60 patients scheduled for thoracoscopic lung segment resection surgery were selected and divided into two groups according to the random number table,with 30 patients in each group.The patients in the observation group received intercostal nerve block under thoracoscope before closing the chest,and the postoperative analgesia pump was Naborphine combined with sufentanil for patient⁃controlled intravenous analgesia;In the control group,the thoracic cavity was closed directly,and sufentanil was used for patient⁃controlled intravenous analgesia.The visual analog pain score(VAS),the number of PCIA effective pressing,the situation of rescue analgesia and the occurrence of related adverse reactions were recorded 2 h,4 h,8 h,24 h and 48 h after surgery.Results The VAS scores at rest of the observation group at 2 h,4 h,8 h,24 h and 48 h after operation 1.8±0.8,1.9±0.8,2.1±0.9,2.3±0.9,2.1±0.8,compared with control group 3.3±1.1,3.5±1.0,2.8±0.9,2.7±0.7,2.6±0.8 were all significantly lower(P<0.05).The VAS scores during activity of the observation group at 2 h,4 h,and 8 h after operation 2.2±0.6,2.3±0.6,2.5±0.9,compared with control group 3.9±1.9、3.9±1.7、3.3±1.7 were significantly lower(P<0.05).The effective press times of PCIA in the observation group within 24 hours and 48 hours after operation were 2.7±1.5 and 5.4±2.3 times,while those in the control group were 5.2±3.4 and 10.2±6.0 times.The difference between the two groups was statistically significant(P<0.05).The number of patients in the observation group receiving postoperative analgesia was less than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The satisfaction rate of patients in the observation group was higher than that in the control group,with a statistically significant difference(P<0.05).Conclusion Thoracoscope assisted intercostal nerve block combined with nalbuphine can be a good choice for postoperative multimodal analgesia in lung segment resection surgery.