BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(T...BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile.展开更多
BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluat...BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.展开更多
This study aimed to exploit a new virtual block method to spare normal lung tissue in VMAT planning for patients with locally advanced non-small cell lung cancer(LA-NSCLC).The previous method was used to manually rest...This study aimed to exploit a new virtual block method to spare normal lung tissue in VMAT planning for patients with locally advanced non-small cell lung cancer(LA-NSCLC).The previous method was used to manually restrict the angle of the beam passing through,which ignored the location and shape of large targets that varied between different slices and did not block the beamlets precisely.Unlike the previous method,this new virtual block method was used to block the beamlets when necessary by closing the multi-leaf collimator(MLC)at prerequisite angles.The algorithm for closing the MLC depended on the thickness of the beamlets passing through the lungs and avoided only the entrance radiation beamlet.Moreover,this block can be automatically contoured.A retrospective study was performed to compare the VMAT plans with and without the virtual block method for 17 LANSCLC patients,named the block plan(B-plan)/non-block plan(N-plan).All cases were selected in this study because of the large tumor size and unmet dose constraints of the lungs.In addition to the maximum dose constraint for the virtual block,B-plans adopted identical optimization parameters to N-plans for each patient.These two types of plans were compared in terms of dosimetric indices and plan scores.The results were statistically analyzed using the Wilcoxon nonparametric signed-rank test.B-plans have advantages in the following dosimetric metrics that have statistical significance(p<0.05):(1)lower V_(5)/V_(10)/D_(mean)/normal tissue complication probability(NTCP)of total lungs;(2)reductions in V_(5)/V_(10)for the contralateral lung;(3)decrease in Dmean/V_(40)of the heart;(4)decrease in esophagus V_(40);(5)reductions in Dmean,V_(5)/V_(10) of normal tissue.B-plans(82.51±7.07)achieved higher-quality scores than N-plans(80.74±7.22).The new virtual block spared the lungs as well as other normal structures in VMAT planning for LA-NSCLC.Thus,the block method may decrease the risk of radiation-related toxicity in patients.展开更多
Objective: The tumor tissues used in molecular pathological detection were usually obtained by surgery, which would cause trauma and may not be suitable for the terminal cancer patients. This paper evaluated the value...Objective: The tumor tissues used in molecular pathological detection were usually obtained by surgery, which would cause trauma and may not be suitable for the terminal cancer patients. This paper evaluated the value of the non-small cell lung cancer(NSCLC) pleural effusion cell blocks as tumor tissues replacement materials in the application of molecular pathological detection. Methods: Tumor cells were made into cell blocks through stratified centrifugal from 30 NSCLC patients with the pleural effusion. The immunohistochemistry, fluorescence in situ hybridization(FISH) and gene sequencing methods were employed in our experiments. Results: The tumor cells of cell block section were rich and could keep part of histological structure. Immunohistochemistry staining could assist diagnosis and tumor parting. Epidermal growth factor receptor(EGFR) FISH-positive was found in 33.33% of the group, high polysomy in 6 cases, amplification in 4 cases. EGFR gene mutations were found in 8 cases of 30 samples, with an incidence of 26.67%, 6 cases were detected in the exon 19, and 2 cases were detected in the exon 21. Conclusion: The NSCLC pleural effusion cell blocks are useful for the diagnosis and determining the primary source of tumor, instructed targeted therapy.展开更多
目的探讨复合罗哌卡因硬膜外阻滞对腹腔镜结直肠癌全身麻醉患者术后疼痛程度的缓解作用。方法选取行腹腔镜结直肠癌根治术的90例患者作为研究对象,用随机数字表法分成对照组与观察组,各45例。对照组行全身麻醉,观察组在全身麻醉的基础...目的探讨复合罗哌卡因硬膜外阻滞对腹腔镜结直肠癌全身麻醉患者术后疼痛程度的缓解作用。方法选取行腹腔镜结直肠癌根治术的90例患者作为研究对象,用随机数字表法分成对照组与观察组,各45例。对照组行全身麻醉,观察组在全身麻醉的基础上复合罗哌卡因硬膜外阻滞。分析2组的临床指标、术后疼痛程度、肺功能及应激反应变化情况。统计2组患者术后不良反应发生率。结果观察组的下床活动时间、首次排气时间及进食时间均短于对照组(P<0.05);术后患者视觉疼痛量表评分(visual analog pain scale,VAS)呈下降趋势,且术后即刻、术后3 h、术后6 h及术后12 h观察组的VAS均低于对照组(P<0.05),但2组术后24 h VAS比较差异无统计学意义(P>0.05);术后24 h,观察组的用力肺活量、第1秒用力呼气量及最大通气量水平均高于对照组,肾上腺素、皮质醇及去甲肾上腺素水平均低于对照组(P<0.05);观察组的不良反应发生率(6.67%)低于对照组(22.22%),P<0.05。结论对腹腔镜结直肠癌全身麻醉手术患者复合罗哌卡因硬膜外阻滞能促进患者术后恢复,缓解术后疼痛程度,保护患者的肺功能,降低应激反应,降低不良反应发生率。展开更多
文摘BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile.
文摘BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.
基金supported by the National Natural Science Foundation of China(No.12105368).
文摘This study aimed to exploit a new virtual block method to spare normal lung tissue in VMAT planning for patients with locally advanced non-small cell lung cancer(LA-NSCLC).The previous method was used to manually restrict the angle of the beam passing through,which ignored the location and shape of large targets that varied between different slices and did not block the beamlets precisely.Unlike the previous method,this new virtual block method was used to block the beamlets when necessary by closing the multi-leaf collimator(MLC)at prerequisite angles.The algorithm for closing the MLC depended on the thickness of the beamlets passing through the lungs and avoided only the entrance radiation beamlet.Moreover,this block can be automatically contoured.A retrospective study was performed to compare the VMAT plans with and without the virtual block method for 17 LANSCLC patients,named the block plan(B-plan)/non-block plan(N-plan).All cases were selected in this study because of the large tumor size and unmet dose constraints of the lungs.In addition to the maximum dose constraint for the virtual block,B-plans adopted identical optimization parameters to N-plans for each patient.These two types of plans were compared in terms of dosimetric indices and plan scores.The results were statistically analyzed using the Wilcoxon nonparametric signed-rank test.B-plans have advantages in the following dosimetric metrics that have statistical significance(p<0.05):(1)lower V_(5)/V_(10)/D_(mean)/normal tissue complication probability(NTCP)of total lungs;(2)reductions in V_(5)/V_(10)for the contralateral lung;(3)decrease in Dmean/V_(40)of the heart;(4)decrease in esophagus V_(40);(5)reductions in Dmean,V_(5)/V_(10) of normal tissue.B-plans(82.51±7.07)achieved higher-quality scores than N-plans(80.74±7.22).The new virtual block spared the lungs as well as other normal structures in VMAT planning for LA-NSCLC.Thus,the block method may decrease the risk of radiation-related toxicity in patients.
文摘Objective: The tumor tissues used in molecular pathological detection were usually obtained by surgery, which would cause trauma and may not be suitable for the terminal cancer patients. This paper evaluated the value of the non-small cell lung cancer(NSCLC) pleural effusion cell blocks as tumor tissues replacement materials in the application of molecular pathological detection. Methods: Tumor cells were made into cell blocks through stratified centrifugal from 30 NSCLC patients with the pleural effusion. The immunohistochemistry, fluorescence in situ hybridization(FISH) and gene sequencing methods were employed in our experiments. Results: The tumor cells of cell block section were rich and could keep part of histological structure. Immunohistochemistry staining could assist diagnosis and tumor parting. Epidermal growth factor receptor(EGFR) FISH-positive was found in 33.33% of the group, high polysomy in 6 cases, amplification in 4 cases. EGFR gene mutations were found in 8 cases of 30 samples, with an incidence of 26.67%, 6 cases were detected in the exon 19, and 2 cases were detected in the exon 21. Conclusion: The NSCLC pleural effusion cell blocks are useful for the diagnosis and determining the primary source of tumor, instructed targeted therapy.
文摘目的探讨复合罗哌卡因硬膜外阻滞对腹腔镜结直肠癌全身麻醉患者术后疼痛程度的缓解作用。方法选取行腹腔镜结直肠癌根治术的90例患者作为研究对象,用随机数字表法分成对照组与观察组,各45例。对照组行全身麻醉,观察组在全身麻醉的基础上复合罗哌卡因硬膜外阻滞。分析2组的临床指标、术后疼痛程度、肺功能及应激反应变化情况。统计2组患者术后不良反应发生率。结果观察组的下床活动时间、首次排气时间及进食时间均短于对照组(P<0.05);术后患者视觉疼痛量表评分(visual analog pain scale,VAS)呈下降趋势,且术后即刻、术后3 h、术后6 h及术后12 h观察组的VAS均低于对照组(P<0.05),但2组术后24 h VAS比较差异无统计学意义(P>0.05);术后24 h,观察组的用力肺活量、第1秒用力呼气量及最大通气量水平均高于对照组,肾上腺素、皮质醇及去甲肾上腺素水平均低于对照组(P<0.05);观察组的不良反应发生率(6.67%)低于对照组(22.22%),P<0.05。结论对腹腔镜结直肠癌全身麻醉手术患者复合罗哌卡因硬膜外阻滞能促进患者术后恢复,缓解术后疼痛程度,保护患者的肺功能,降低应激反应,降低不良反应发生率。
