摘要
目的探讨超声引导下胸椎旁神经阻滞(TPNB)对中老年肺癌根治术患者麻醉效果及应激反应的影响。方法选取2020年11月至2023年5月在青岛市中医医院行胸腔镜肺癌根治术治疗的104例肺癌患者,采用随机数字表法分为观察组(52例)和对照组(52例)。观察组患者术中采取全身麻醉(简称全麻)联合超声引导下TPNB方式麻醉,对照组采取全麻方式。对比两组患者手术时间、术中出血量及瑞芬太尼、丙泊酚用量,患者的平均动脉压(MAP)、心率(HR)波动趋势,患者术后静息状态、咳嗽状态的疼痛程度,手术前后患者血清应激反应指标[空腹血糖(FPG)、皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]差异及不良反应。结果观察组和对照组患者的手术时间、术中出血量、单肺通气时间比较,差异均无统计学意义(均P>0.05)。观察组患者的瑞芬太尼、丙泊酚用量均少于对照组,差异有统计学意义(均P<0.05)。观察组麻醉诱导前、术中30min、术中90min、术毕四个时间点的MAP波动变化较对照组更小,其中术中30min、术中90min的MAP高于对照组(均P<0.05);观察组和对照组患者四个时间点的HR波动变化差异无统计学意义(均P>0.05)。观察组患者术后12h、24h的静息状态、咳嗽状态下视觉模拟疼痛量表(VAS)评分均低于同一时间点、同一状态下的对照组(均P<0.05)。观察组术后12h血清Cor、E水平低于对照组,术后12h、24h血清NE水平均低于对照组(均P<0.05)。观察组患者因麻醉方式引起的不良反应发生率低于对照组(P<0.05)。结论肺癌根治性手术患者采用超声引导下TPNB结合全麻的方式,有利于减少术中血压波动、减轻术后疼痛程度及应激反应程度,且有利于减少麻醉引起的不良反应。
Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block(TPNB)on anesthesia efficacy and stress response in middle-aged and elderly patients undergoing radical surgery for lung cancer.Methods A total of 104 lung cancer patients who underwent thoracoscopic radical resection for lung cancer at Qingdao Traditional Chinese Medicine Hospital from November 2020 to May 2023 were selected and randomly divided into an observation group(52 cases)and a control group(52 cases)using a random number table method.The observation group received general anesthesia combined with ultrasound-guided TPNB anesthesia during surgery,while the control group received general anesthesia.Two groups of patients were compared in terms of surgical time,intraoperative blood loss,remifentanil and propofol dosage,fluctuation trends of mean arterial pressure(MAP)and heart rate(HR),pain levels in resting and coughing states after surgery,differences in serum stress response indicators[fasting plasma glucose(FPG),cortisol(Cor),norepinephrine(NE),epinephrine(E)] before and after surgery,and adverse reactions.Results There was no statistically significant difference in surgical time,intraoperative blood loss,and single lung ventilation time between the observation group and the control group(all P>0.05).The usage of remifentanil and propofol in the observation group was lower than that in the control group,and the difference was statistically significant(all P<0.05).The MAP fluctuation changes at four time points before anesthesia induction,30 minutes during surgery,90 minutes during surgery,and after surgery in the observation group were smaller than those in the control group.Among them,the MAP at 30 minutes during surgery and 90 minutes during surgery was higher than that in the control group(all P<0.05);There was no statistically significant difference in HR fluctuations between the observation group and the control group at the four time points(all P>0.05).The Visual Analog Scale(VAS)scores of the observation group patients in resting and coughing states at 12 and 24 hours after surgery were lower than those of the control group at the same time point(all P<0.05).The serum Cor and E levels in the observation group were lower than those in the control group at 12 hours after surgery,and the serum NE levels were lower than those in the control group at 12 and 24 hours after surgery(all P<0.05).The incidence of adverse reactions caused by anesthesia in the observation group was lower than that in the control group(P<0.05).Conclusions The use of ultrasound-guided TPNB combined with general anesthesia in patients undergoing radical surgery for lung cancer is beneficial in reducing intraoperative blood pressure fluctuations,alleviating postoperative pain and stress response,and reducing adverse reactions caused by anesthesia.
作者
卜会敏
赵敏
逄坤芳
田晓鹏
Bu Huimin;Zhao Min;Pang Kunfang;Tian Xiaopeng(Department of Anesthesiology and Surgery,Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital),Qingdao 266033,China)
出处
《中国医师杂志》
CAS
2024年第7期1071-1075,共5页
Journal of Chinese Physician
关键词
肺肿瘤
胸腔镜检查
椎旁神经阻滞
超声检查
Lung neoplasms
Thoracoscopy
Paravertebral nerve block
Ultrasonography