Effects of thoracic paravertebral nerve block on postoperative analgesia and hemodynamics in patients with lung cancer
陈刚 1李争卫 1孙勇
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 西安医学院第一附属医院 西安医学院全科医学院麻醉科，西安 710077
折叠
摘要
目的 探讨胸椎旁神经阻滞对肺癌全麻术后镇痛及血流动力学的影响。 方法 收集2017年1月至2019年12月本院收治的肺癌患者126例，均行全身麻醉下胸腔镜肺癌根治术。随机数字表法将患者分为对照组和研究组，每组63例，分别行全身麻醉、麻醉诱导前胸椎旁神经阻滞联合全身麻醉。比较两组术后不良反应、术后住院时间、舒芬太尼用量。比较两组不同时点的疼痛程度，比较两组患者的应激状态和血流动力学指标。 结果 研究组术后不良反应发生率、术后住院时间、舒芬太尼用量均低于对照组（均P<0.05）。术后2 h、6 h、12 h、1 d、2 d研究组VAS评分较对照组均显著降低（均P<0.05）。与术前相比，术后2 h两组患者血清肾上腺素（E）、去甲肾上腺素（NE）、血管紧张素Ⅱ（AngⅡ）等各项应激状态指标均升高（均P<0.05）；与同时点对照组相比，术后2 h研究组血清E、NE、AngII水平均降低（均P<0.05）。气管插管后、切皮后5 min，对照组心率（HR）、平均动脉压（MAP）均较入室时降低，拔管时高于入室时（均P<0.05）；切皮后5 min研究组HR、MAP均较入室时降低（均P<0.05），气管插管后、拔管时研究组HR、MAP与入室时比较，差异无统计学意义（均P>0.05）。气管插管后、切皮后5 min研究组HR、MAP均高于对照组，拔管时均低于对照组（均P<0.05）。 结论 肺癌全麻手术患者麻醉诱导前行胸椎旁神经阻滞能够减少舒芬太尼用量及不良反应，减轻应激反应，有利于维持术中血流动力学稳定。 Objective To investigate the effect of thoracic paravertebral nerve block on postoperative analgesia and hemodynamics in patients with lung cancer under general anesthesia. Methods A total of 126 patients with lung cancer admitted to our hospital from January 2017 to December 2019 were collected. All patients underwent thoracoscopic radical resection of lung cancer under general anesthesia. The patients were divided into control group and study group by random number table method with 63 cases in each group, and general anesthesia or pre-anesthesia induction of thoracic paravertebral nerve block combined with general anesthesia were performed respectively. The postoperative adverse reactions, postoperative hospitalization stay and sufentanil dosage were compared between the two groups. The pain degree of the two groups at different time points was compared, and the stress state and hemodynamic indexes of the two groups were compared. Results The incidence of postoperative adverse reactions, postoperative hospital stay and dosage of sufentanil in the study group were lower than those in the control group (all P<0.05). The VAS scores of the study group were significantly lower than those of the control group at 2 h, 6 h, 12 h, 1 d and 2 d after operation (allP<0.05). Compared with those before operation, the levels of serum epinephrine (E), norepinephrine (NE), angiotensinⅡ (AngⅡ) and other stress indexes were increased in both groups at 2 h after operation (allP<0.05). Compared with the control group at the same time point, the levels of serum E, NE and AngⅡ in the study group decreased at 2 h after operation (allP<0.05). After tracheal intubation and 5 min after skin incision, the heart rate (HR) and mean arterial pressure (MAP) of the control group were lower, while those at extubation were higher than those at the time of entry (allP<0.05). Five min after skin incision, HR and MAP in the study group were lower than those at the time of entry (bothP<0.05). There was no significant difference in HR and MAP between the study group after tracheal intubation, at extubation and at the time of entry (bothP>0.05). After tracheal intubation and 5 min after skin incision, HR and MAP in the study group were higher than those in the control group, and lower than those in the control group at extubation (allP<0.05) . Conclusion Thoracic paravertebral nerve block before anesthesia induction in patients with lung cancer undergoing general anesthesia can reduce the dosage of sufentanil and adverse reactions, reduce stress response, and help to maintain intraoperative hemodynamic stability.
Abstract
Objective To investigate the effect of thoracic paravertebral nerve block on postoperative analgesia and hemodynamics in patients with lung cancer under general anesthesia. Methods A total of 126 patients with lung cancer admitted to our hospital from January 2017 to December 2019 were collected. All patients underwent thoracoscopic radical resection of lung cancer under general anesthesia. The patients were divided into control group and study group by random number table method with 63 cases in each group, and general anesthesia or pre-anesthesia induction of thoracic paravertebral nerve block combined with general anesthesia were performed respectively. The postoperative adverse reactions, postoperative hospitalization stay and sufentanil dosage were compared between the two groups. The pain degree of the two groups at different time points was compared, and the stress state and hemodynamic indexes of the two groups were compared. Results The incidence of postoperative adverse reactions, postoperative hospital stay and dosage of sufentanil in the study group were lower than those in the control group (all P<0.05). The VAS scores of the study group were significantly lower than those of the control group at 2 h, 6 h, 12 h, 1 d and 2 d after operation (allP<0.05). Compared with those before operation, the levels of serum epinephrine (E), norepinephrine (NE), angiotensinⅡ (AngⅡ) and other stress indexes were increased in both groups at 2 h after operation (allP<0.05). Compared with the control group at the same time point, the levels of serum E, NE and AngⅡ in the study group decreased at 2 h after operation (allP<0.05). After tracheal intubation and 5 min after skin incision, the heart rate (HR) and mean arterial pressure (MAP) of the control group were lower, while those at extubation were higher than those at the time of entry (allP<0.05). Five min after skin incision, HR and MAP in the study group were lower than those at the time of entry (bothP<0.05). There was no significant difference in HR and MAP between the study group after tracheal intubation, at extubation and at the time of entry (bothP>0.05). After tracheal intubation and 5 min after skin incision, HR and MAP in the study group were higher than those in the control group, and lower than those in the control group at extubation (allP<0.05) . Conclusion Thoracic paravertebral nerve block before anesthesia induction in patients with lung cancer undergoing general anesthesia can reduce the dosage of sufentanil and adverse reactions, reduce stress response, and help to maintain intraoperative hemodynamic stability.
万方数据