Effect of TPVB combined with PCIA on hemodynamics in elderly patients undergoing thoracoscopic surgery under ultrasound localization
Objective To analyze the effect of thoracic paravertebral nerve block(TPVB)com-bined with patient controlled intravenous analgesia(PCIA)on hemodynamics in elderly patients undergoing thoracoscopic surgery under ultrasound localization.Methods Eighty-nine patients undergoing elective thoracoscopic lobectomy admitted to our hospital from December 2020 to June 2023 were selected as the study objects,and were divided into observation group(n=44)and control group(n=45)by random number table method.The observation group was given TPVB combined with PCIA under ultrasound localization,and the control group was given erec-tor spinae plane block(ESPB)combined with PCIA under ultrasound localization.PCIA and sufentanil dosage,hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP)],visual analogue scale(VAS)score at different time points,inflammatory response before and after surgery[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)],mini mental state examination(MMSE),General Comfort Questionnaire(GCQ)score,and the incidence of adverse reactions of the two groups were compared.Results The total PCIA infusion,the number of compressions and the dosage of sufentanil in the observation group were lower than those in the control group(P＜0.05).There was no significant differ-ence in HR and MAP between the two groups at T0～T3(P＞0.05),but compared with T0,HR and MAP decreased significantly at T1～T3(P＜0.05).The postoperative VAS score of the two groups increased gradually at rest,and the postoperative 6 h VAS score of the coughing group was the highest,and then gradually decreased.The postoperative VAS score of the ob-servation group was lower than that of the control group at different time points(P＜0.05).After operation,the levels of TNF-α,IL-6 and IL-8 in both groups were higher than those be-fore operation(P＜0.05),but the levels of TNF-α,IL-6 and IL-8 in observation group were lower than those in control group(P＜0.05).After operation,MMSE and GCQ scores in both groups were lower than before operation(P＜0.05),but MMSE and GCQ scores in observa-tion group were higher than those in control group(P＜0.05).There was no significant differ-ence in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion TPVB combined with PCIA requires less narcotic drugs and has better effect,and TPVB under ultrasound positioning can further promote the recovery of patients'cognitive function and is sa-fer and more reliable.
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