全麻联合胸椎旁神经阻滞对肺癌手术患者术后镇痛和肺部感染的影响

doi:10.11958/20221629

天津医药 ›› 2023, Vol. 51 ›› Issue (6): 648-652.doi: 10.11958/20221629

全麻联合胸椎旁神经阻滞对肺癌手术患者术后镇痛和肺部感染的影响

吴克义¹(), 黄勇¹, 许成浩¹, 马天鸣¹, 代飞彪², 李雪², 唐朝亮²^,^△

1 安徽省庐江县人民医院麻醉科（邮编231500）
2 中国科学技术大学附属第一医院麻醉科

收稿日期:2022-10-10 修回日期:2023-01-08 出版日期:2023-06-15 发布日期:2023-06-20
通讯作者: ^△E-mail：chaolt@ustc.edu.cn
作者简介:吴克义（1979），男，在职研究生，副主任医师，主要从事临床麻醉方面研究。E-mail：wuke_yi@163.com

Effects of general anesthesia combined with thoracic paravertebral nerve block on postoperative analgesia and pulmonary infection in patients with lung cancer surgery

WU Keyi¹(), HUANG Yong¹, XU Chenghao¹, MA Tianming¹, DAI Feibiao², LI Xue², TANG Chaoliang²^,^△

1 Department of Anesthesiology, Anhui Lujiang General Hospital, Hefei 231500, China
2 Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China

Received:2022-10-10 Revised:2023-01-08 Published:2023-06-15 Online:2023-06-20
Contact: ^△E-mail：chaolt@ustc.edu.cn

吴克义, 黄勇, 许成浩, 马天鸣, 代飞彪, 李雪, 唐朝亮. 全麻联合胸椎旁神经阻滞对肺癌手术患者术后镇痛和肺部感染的影响[J]. 天津医药, 2023, 51(6): 648-652.

WU Keyi, HUANG Yong, XU Chenghao, MA Tianming, DAI Feibiao, LI Xue, TANG Chaoliang. Effects of general anesthesia combined with thoracic paravertebral nerve block on postoperative analgesia and pulmonary infection in patients with lung cancer surgery[J]. Tianjin Medical Journal, 2023, 51(6): 648-652.

摘要/Abstract

摘要：

目的探究全麻（GA）联合胸椎旁神经阻滞（TPVB）对肺癌手术患者术后镇痛和肺部感染的影响。方法接受胸腔镜下肺叶切除术的170例肺癌患者按用药方案分为GA组80例与GA联合TPVB组（联合组）90例。比较2组术中麻醉药物使用量，术后镇痛泵按压次数，麻醉诱导前、麻醉诱导后及术毕舒张压（DBP）、收缩压（SBP）、心率（HR），术后48 h内疼痛视觉模拟评分（VAS）评估疼痛情况；酶联免疫吸附试验检测2组手术前后白细胞介素（IL）-6、肿瘤坏死因子-α（TNF-α）、IL-8水平；比较2组术后恢复时间、肺部感染和麻醉不良反应发生率。结果联合组术中瑞芬太尼、丙泊酚使用量，术后镇痛泵按压次数低于GA组（P<0.05）；联合组麻醉诱导后及术毕DBP、SBP、HR高于GA组（P<0.05）；联合组术后4、8、12、24、48 h VAS评分低于GA组（P<0.05）；联合组术后IL-6、TNF-α、IL-8水平低于GA组（P<0.05）；联合组术后自主呼吸恢复、拔管、苏醒室留置、术后首次下床、住院时间低于GA组（P<0.05）；联合组术后肺部感染和麻醉不良反应发生率低于GA组（P<0.05）。结论肺癌手术患者麻醉应用GA联合TPVB术后镇痛效果优异，有助于降低患者术后肺部感染发生率。

关键词: 肺肿瘤, 神经传导阻滞, 胸椎, 麻醉, 全身, 术后镇痛, 肺部感染

Abstract:

Objective To investigate the effect of general anesthesia (GA) combined with thoracic paravertebral nerve block (TPVB) on postoperative analgesia and pulmonary infection in patients undergoing lung cancer surgery. Methods A total of 170 lung cancer patients who underwent thoracoscopic lung lobectomy were divided into the GA group (80 cases) and the GA combined with TPVB group (90 cases) according to the anesthetic regimen. Intraoperative dosage of anesthetics, postoperative pressing times of analgesic pump, diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) before anesthesia induction, after anesthesia induction and after operation, and pain (VAS) score within 48 h after operation were compared between the two groups. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) were measured by enzyme-related immunosorbent assay before and after surgery in the two groups. The postoperative recovery time and the incidence rates of pulmonary infection and adverse anesthesia reactions were compared between the groups. Results The dosages of remifentanil, propofol and the total pressing times were lower in the GA combined with TPVB group than those in the GA group (P<0.05). DBP, SBP and HR after anesthesia induction and after operation were higher in the GA combined with TPVB group than those of the GA group (P<0.05). The VAS scores at 4, 8, 12, 24 and 48 h after operation were lower in the GA combined with TPVB group than those of the GA group (P<0.05). After operation, levels of IL-6, TNF-α and IL-8 were lower in the GA combined with TPVB group than those in the GA group (P<0.05). The recovery time of spontaneous breathing, extubation time, length of stay in recovery room, postoperative first ambulation time and hospital stay were shorter in the GA combined with TPVB group than those of the GA group (P<0.05). The incidence rates of postoperative pulmonary infection and adverse anesthesia reactions were lower in the GA combined with TPVB group than those in the GA group (P<0.05). Conclusion GA combined with TPVB can achieve good analgesic effect on patients undergoing lung cancer surgery and reduce the incidence of postoperative pulmonary infection.

Key words: lung neoplasms, nerve block, thoracic vertebrae, anesthesia, general, postoperative analgesia, pulmonary infection

中图分类号:

R734.2，R614.2

图/表 7

参考文献 22

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组别		n	性别（男/女）			年龄（岁）
GA组		80	31/49			58.61±13.12
联合组		90	43/47			59.47±10.66
χ²或t			1.404			0.468
组别	BMI（kg/m²）			病理分型			临床分期
组别	BMI（kg/m²）			鳞癌	腺癌		Ⅰ期	Ⅱ期
GA组	24.25±3.33			23	57		47	33
联合组	24.22±2.35			22	68		59	31
χ²或t	0.081			0.403			0.836

组别		n	性别（男/女）			年龄（岁）
GA组		80	31/49			58.61±13.12
联合组		90	43/47			59.47±10.66
χ²或t			1.404			0.468
组别	BMI（kg/m²）			病理分型			临床分期
组别	BMI（kg/m²）			鳞癌	腺癌		Ⅰ期	Ⅱ期
GA组	24.25±3.33			23	57		47	33
联合组	24.22±2.35			22	68		59	31
χ²或t	0.081			0.403			0.836

组别	n	瑞芬太尼用量（mg）	丙泊酚用量（mg）	镇痛泵按压次数（次）
GA组	80	1.61±0.20	507.93±32.57	11.50±0.78
联合组	90	1.32±0.18	343.44±34.38	6.14±0.61
t		10.021^＊＊	31.914^＊＊	49.449^＊＊

组别	n	瑞芬太尼用量（mg）	丙泊酚用量（mg）	镇痛泵按压次数（次）
GA组	80	1.61±0.20	507.93±32.57	11.50±0.78
联合组	90	1.32±0.18	343.44±34.38	6.14±0.61
t		10.021^＊＊	31.914^＊＊	49.449^＊＊

组别	n	DBP（mmHg）			SBP（mmHg）			HR（次/min）
组别	n	麻醉诱导前	麻醉诱导后	术毕	麻醉诱导前	麻醉诱导后	术毕	麻醉诱导前	麻醉诱导后	术毕
GA组	80	85.30±5.90	77.59±7.54^a	79.53±5.86^a	121.84±8.53	107.24±7.59^a	112.06±10.03^ab	82.04±6.39	73.94±5.93^a	76.23±6.09^ab
联合组	90	86.14±5.48	82.28±5.04^a	83.38±5.19^a	119.52±8.56	115.86±8.42^a	117.46±10.69^a	82.99±5.92	79.62±5.83^a	79.88±5.28^a
t		0.968	4.710^＊＊	4.549^＊＊	1.763	6.976^＊＊	3.379^＊＊	1.008	7.443^＊＊	4.188^＊＊

全麻联合胸椎旁神经阻滞对肺癌手术患者术后镇痛和肺部感染的影响

Effects of general anesthesia combined with thoracic paravertebral nerve block on postoperative analgesia and pulmonary infection in patients with lung cancer surgery

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组别	n	4 h	8 h	12 h	24 h	48 h
GA组	80	1.08±0.27	1.71±0.46^a	2.24±0.51^ab	1.85±0.55^ac	1.14±0.41^bcd
联合组	90	0.92±0.27	1.26±0.46^a	1.83±0.55^ab	1.21±0.41^ac	0.97±0.18^bcd
t		3.719^＊＊	6.468^＊＊	4.974^＊＊	8.609^＊＊	3.419^＊＊

组别	n	IL-6			TNF-α			IL-8
组别	n	术前	术后	t	术前	术后	t	术前	术后	t
GA组	80	5.08±0.82	56.37±3.41	138.553^＊＊	8.89±2.27	43.55±4.52	59.125^＊＊	9.37±1.44	21.24±2.83	33.210^＊＊
联合组	90	5.30±0.90	36.94±4.36	69.303^＊＊	9.07±2.71	33.04±4.61	44.424^＊＊	9.11±1.76	15.09±2.70	18.028^＊＊
t		1.730	32.547^＊＊		0.479	14.977^＊＊		1.061	14.495^＊＊

组别	n	自主呼吸恢复时间（min）	拔管时间（min）	苏醒室留置时间（min）	术后首次下床时间（h）	住院时间（d）
GA组	80	16.75±4.00	27.46±6.48	48.46±15.62	21.35±4.86	7.48±1.24
联合组	90	10.48±3.43	22.43±6.34	39.94±9.35	15.63±5.12	5.51±0.82
t		11.009^＊＊	5.111^＊＊	4.248^＊＊	7.445^＊＊	11.986^＊＊

组别	n	肺部感染	麻醉不良反应
组别	n	肺部感染	呼吸抑制	呕吐	嗜睡	恶心	头晕	总计
GA组	80	8（10.00）	3（3.75）	3（3.75）	4（5.00）	5（6.25）	2（2.50）	17（21.25）
联合组	90	1（1.11）	1（1.11）	2（2.22）	2（2.22）	3（3.33）	0	8（8.89）
χ²		5.019^＊						5.159^＊

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