胸腔内迷走神经阻滞对肺叶切除术患者术后恶心呕吐的影响

Effect of intrathoracic vagus nerve block on postoperative nausea and vomiting in patients undergoing lobectomy

目的 通过观察胸腔内迷走神经阻滞对肺叶切除术患者术后恶心呕吐(PONV)的影响,验证胃肠-迷走神经-脑轴在肺叶切除术PONV中起到重要的作用。方法 选择择期行胸腔镜下右侧肺叶切除术的女性患者180例,年龄30~75岁,BMI 18~30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:胸腔内迷走神经阻滞组(VB组)和对照组(C组),每组90例。术中由外科医师在胸腔镜下对VB组使用0.75%罗哌卡因2.5 ml行气管下段右侧迷走神经阻滞,C组不行胸腔内迷走神经阻滞。记录肺叶切除术后24 h内PONV发生情况。记录术后24 h内首次肛门排气和排便情况、补救性止吐药应用情况、术后24 h数字疼痛评分量表(NRS)评分、意识模糊评估法-中文修订版(CAM-CR)评分。记录术后24 h内咳嗽、低血压等不良反应发生情况。结果 两组患者年龄、BMI、ASA分级、晕动症、PONV病史、高血压和糖尿病发生率差异无统计学意义。两组无一例吸烟、哮喘病史。与C组比较,术后24 h内VB组PONV发生率明显降低[24(27%) vs 39 (43%),(P<0.05)]。两组术后24 h内首次肛门排气和排便情况、补救性止吐药应用情况、术后24 h NRS评分、CAM-CR评分差异无统计学意义。两组术后24 h内无一例咳嗽、低血压等不良反应。结论 肺叶切除术中胸腔内迷走神经阻滞能够有效减少PONV的发生,提示迷走传入神经在介导PONV的发生中起到重要的作用。

Objective To evaluate the crucial role of gut-vagus-brain axis in postoperative nausea and vomiting(PONV) by investigating the effect of intrathoracic vagus nerve block on PONV in patients with lobectomy.Methods A total of 180 female patients undergoing elective thoracoscopic right lobectomy,aged 30-75 years,BMI 18-30 kg/m^(2),ASA physical status Ⅰ-Ⅲ,were selected.Patients were divided into two groups by random number table method:the intrathoracic vagus nerve block group(group VB) and the control group(group C),90 patients in each group.During the operation,the surgeons used 0.75% ropivacaine 2.5 ml to perform the right vagus nerve block in the lower part of the trachea under thoracoscopy in group VB,and no intrathoracic vagus nerve block was performed in the group C.The incidence of PONV within 24 hours after lobectomy was recorded.The first anal exhaust and defecation within 24 hours after surgery,the use of rescue antiemetic drugs,the numerical rating scale(NRS) score and the confusion assessment method-Chinese revision(CAM-CR) score at 24 hours after surgery were recorded.The occurrence of adverse reactions such as cough and hypotension within 24 hours after surgery was recorded.Results There was no significant difference in age,BMI,ASA physical status,motion sickness,PONV history,hypertension and diabetes incidence between the two groups.There was no history of smoking or asthma in either group.Compared with group C,the incidence of PONV in group VB was significantly decreased within 24 hours after surgery [24(27%) vs 39(43%),P < 0.05].There was no significant difference in the first anal exhaust and defecation within 24 hours after surgery,the use of rescue antiemetic drugs,NRS score and CAM-CR score at 24 hours after surgery between the two groups.There was no cough,hypotension and other adverse reactions in the two groups within 24 hours after surgery.Conclusion Intrathoracic vagus nerve block during lobectomy can effectively reduce the occurrence of PONV,suggesting that the afferent vagus nerve plays a key role in mediating the occurrence of PONV.