摘要
目的:观察胸椎旁神经阻滞联合全身麻醉在老年胸腔镜肺癌根治术患者中的应用效果.方法:选取 2020 年 5 月至 2022 年5月该院收治的60例老年肺癌患者进行前瞻性研究,按照随机数字表法将其分为对照组与观察组各30例.两组均行胸腔镜肺癌根治术治疗,对照组采用全身麻醉,观察组在对照组基础上联合胸椎旁神经阻滞.比较两组不同时间(麻醉前、麻醉后 15 min、术后 5 min)血流动力学指标(平均动脉压、心率)水平、术后不同时间(术后 2、6、12、24 h)疼痛[视觉模拟评分法(VAS)]评分、手术前后应激指标[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、胰岛素(INS)]水平和不良反应发生率.结果:麻醉后 15 min、术后 5 min,两组平均动脉压、心率水平均低于麻醉前,但观察组高于对照组,差异有统计学意义(P<0.05);观察组术后 2、6、12、24 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后 1、3 d,两组NE、E、Cor、INS水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:胸椎旁神经阻滞联合全身麻醉应用于老年胸腔镜肺癌根治术患者可改善血流动力学指标水平,降低疼痛评分和应激指标水平,效果优于单纯全身麻醉.
Abstract
Objective:To observe application effects of thoracic paravertebral nerve block combined with general anesthesia in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:A prospective study was conducted on 60 elderly patients with lung cancer admitted to this hospital from May 2020 to May 2022.They were divided into control group and observation group according to the random number table method,30 cases in each group.Both groups were treated with thoracoscopic radical resection of lung cancer.The control group was treated with general anesthesia,while the observation group was combined with thoracic paravertebral nerve block on the basis of that of the control group.The hemodynamic indexes(mean arterial pressure,heart rate)at different time(before anesthesia,15 min after anesthesia,5 min after the surgery),the pain[visual analogue scale(VAS)]scores at different time(2,6,12,24 h after the surgery),the stress indexes[norepinephrine(NE),epinephrine(E),cortisol(Cor),insulin(INS)]levels before and after the surgery,and the incidence of adverse reactions were compared between the two groups.Results:15 min after anesthesia and 5 min after the surgery,the mean arterial pressure and heart rate levels of the two groups were lower than those before anesthesia,but those in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores of the observation group 2,6,12 and 24 h after the surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).1 and 3 days after the surgery,the levels of NE,E,Cor and INS in the two groups were higher than those before the surgery,but those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:The thoracic paravertebral nerve block combined with general anesthesia in the elderly patients undergoing thoracoscopic radical resection of lung cancer can improve the levels of hemodynamic indexes,reduce the pain scores and the stress index levels.Moreover,it is superior to single general anesthesia.
维普
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