目的 探讨甲钴胺及复方倍他米松用于胸椎旁神经阻滞(TPVB)对胸腔镜手术(VATS)患者术后急性疼痛和恢复质量的影响.方法 选择2023年1月至2023年7月在江苏大学附属徐州医院(徐州市肿瘤医院)择期行VATS的220例患者,采用随机数字表法分为甲钴胺及复方倍他米松复合罗哌卡因TPVB组(E组)、甲钴胺复合罗哌卡因TPVB组(M组)、复方倍他米松复合罗哌卡因TPVB组(B组)和单纯罗哌卡因TPVB组(C组),每组各55例,均于全麻诱导前行TPVB.记录4组患者术中丙泊酚、瑞芬太尼用量及血管活性药使用率,术后48 h内镇痛情况,术后第2、6、24、48 h静息及活动时疼痛数字量表(NRS)评分,术前1 d、术后1 d和术后3d的40项恢复质量量表(QoR-40)评分,术后不良反应发生情况和术后住院时间.结果 4组患者术中丙泊酚、瑞芬太尼用量、血管活性药物使用率,术后48 h内镇痛情况比较,差异均无统计学意义(均P＞0.05).与C组比较,E组术后6、24、48 h静息时和活动时的NRS评分均显著降低,M组术后24 h静息时的NRS评分显著降低,B组术后6和24 h静息时和活动时的NRS评分均显著降低(均P＜0.05).与C组比较,E组、M组和B组术后1 d QoR-40评分显著升高,与M组比较,E组和B组术后1 d QoR-40评分均显著升高(均P＜0.05).4组术后3 d QoR-40评分、术后不良反应发生情况和术后住院时间比较,差异均无统计学意义(均P＞0.05).结论 甲钴胺及复方倍他米松复合罗哌卡因行TPVB可以减轻VATS患者术后急性疼痛,促进术后恢复.
Effects of mecobalamin and compound betamethasone used in thoracic paravertebral nerve block on postoperative acute pain and recovery quality in patients undergoing video-assisted thoracic surgery
Objective To investigate the effects of mecobalamin and compound betamethasone used in thoracic paravertebral nerve block(TPVB)on postoperative acute pain and recovery quality in patients undergoing video-assisted thoracic surgery(VATS).Methods A total of 220 patients who underwent VATS under general anesthesia at Xuzhou Hospital affiliated to Jiangsu University(Xuzhou Cancer Hospital)from January 2023 to July 2023 were randomly divided into four groups,with 55 patients in each group:mecobalamin and compound betamethasone combined with ropivacaine TPVB group(group E),mecobalamin combined with ropivacaine TPVB group(group M),compound betamethasone combined with ropivacaine TPVB group(group B)and ropivacaine TPVB group(group C).All patients underwent TPVB before general anesthesia induction.The intraoperative dosage of propofol and remifentanil,the usage rate of vasoactive drugs,and the analgesia within 48 hours after surgery were recorded in the four groups.The numerical rating scale(NRS)pain scores at rest and during activity at 2,6,24,and 48 h after surgery were also recorded,so were the 40-items quality-of-recovery scale(QoR-40)scores one day before surgery,and one and three days after surgery,the occurrence of postoperative adverse reactions,and the duration of postoperative hospitalization.Results There were no statistically significant differences in the intraoperative propofol and remifentanil dosage,the usage rate of vasoactive drugs and the analgesia within 48 hours after surgery among the four groups(all P＞0.05).Compared with group C,the NRS scores at rest and during activity at 6,24 and 48 h after surgery in group E were significantly decreased,the NRS scores at rest 24 h after surgery in group M,and the scores at rest and during activity at 6 and 24 h after surgery in group B were also significantly decreased(all P＜0.05).Compared with group C,the QoR-40 scores of groups E,M and B were significantly higher on the first day after surgery;compared with group M,the QoR-40 scores of groups E and B were significantly higher on the first day after surgery(all P＜0.05).There were no statistically significant differences in the QoR-40 scores on the third day after surgery,occurrence of postoperative adverse reactions and postoperative hospitalization time among the four groups(all P＞0.05).Conclusion TPVB treated with mecobalamin and compound betamethasone combined with ropivacaine can effectively reduce acute postoperative pain and promote postoperative recovery of patients with VATS.
万方数据
维普
