不同模式神经阻滞联合全麻在老年VATS术后中的镇痛效果及安全性对比观察

Comparative Observation on Analgesic Effect and Safety of Different Modes of Nerve Block Combined with General Anaesthesia After VATS in Elderly Patients

目的 观察不同模式神经阻滞联合全麻在老年电视辅助胸腔镜(VATS)术后中的镇痛效果及安全性差异。方法 将在河北中石油中心医院胸外科择期行全麻下VATS肺叶切除术的80例患者分为3组。T组27例患者行胸椎旁神经阻滞(TPVB),E组26例患者行竖脊肌平面阻滞(ESPB),I组27例患者行肋间神经阻滞(ICNB),术毕使用静脉自控镇痛(PCIA)。比较3组镇痛效果、炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、IL-10]及安全性。结果 E组和T组术后镇痛泵首次按压时间长于I组,术后48 h内镇痛泵有效按压次数少于I组(均P <0.05)。3组术后4、8、12、24 h静息和咳嗽时疼痛视觉模拟法(VAS)评分均较术后2 h升高(P <0.05)。E组和T组术后8、12、24h静息时疼痛VAS评分及术后4、8、12、24h咳嗽时疼痛VAS评分均低于I组(P <0.05)。3组术后12、24h炎症因子水平均较术前升高(P <0.05)。E组和T组术后炎症因子水平低于I组(P <0.05)。T组术后炎症因子水平低于E组(P <0.05)。结论 TPVB与ESPB用于老年VATS术后镇痛效果相似,TPVB对机体炎症反应的抑制作用更强,且未增加不良反应。

Objective To observe the differences in analgesic effects and safety of different modes of nerve block combined with general anaesthesia after television-assisted thoracoscopy(VATS)in the elderly.Methods Eighty patients who underwent VATS lobectomy under general anaesthesia in the elective thoracic surgery department of our hospital were divided into three groups.27 patients in group T underwent thoracic paravertebral nerve block(TPVB),26 patients in group E underwent erector spinae plane block(ESPB),and 27 patients in group I underwent intercostal nerve block(ICNB),with the use of intravenous controlled analgesia(PCIA)at the end of the operation.The clinical effects and safety of the three groups were compared.Results The time to first postoperative analgesic pump pressure was longer in Groups E and T than in Group I,and the number of effective analgesic pump presses was less than in Group I in the 48h postoperative period(P<0.05).The visual analogue scale(VAS)scores at rest and cough were higher in all three groups at 4,8,12,and 24h postoperatively than at 2h postoperatively(P<0.05).The VAS scores at rest at 8,12,and 24h postoperatively,and the VAS scores at cough at 4,8,12,and 24h postoperatively in groups E and T were lower than those in group I(P<0.05).Inflammatory factors were higher in all three groups at 12 and 24h postoperatively than preoperatively(P<0.05).Postoperative inflammatory factors were lower in groups E and T than in group I(P<0.05).Postoperative inflammatory factors were lower in group T than in group E(P<0.05).Conclusion TPVB and ESPB provide similar analgesic effects in elderly patients after VATS,with TPVB exhibiting a stronger inhibitory effect on the body's inflammatory response,without increasing adverse reactions.