文章摘要
胸椎旁程控间歇脉冲注药对胸腔镜肺叶切除患者术后急性疼痛和早期恢复质量的影响
Effect of paravertebral programmed intermittent bolus infusion on acute pain and early recovery quality in patients undergoing thoracoscopic lobectomy
  
DOI：10.12089/jca.2021.06.011
中文关键词: 程控间歇脉冲注药  胸椎旁阻滞  胸腔镜  肺叶切除术  术后镇痛
英文关键词: Programmed intermittent bolus  Thoracic paravertebral block  Thoracoscopg  Lobectomy  Postoperative analgesia
基金项目:通州区高层次人才发展支持计划（YHLD2019010）
作者单位E-mail
王菲 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科  
罗太君 北京积水潭医院麻醉科  
高广阔 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科  
刘涛 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科  
陈玢 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科  
翟文廷 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科  
刘伟 101149,北京市结核病胸部肿瘤研究所,首都医科大学附属北京胸科医院麻醉科 lw1200@sina.com 
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中文摘要:
      
目的 探讨胸椎旁程控间歇脉冲注药对胸腔镜肺叶切除患者术后镇痛效果和早期恢复质量的影响。
方法 选择拟在本院行胸腔镜下肺叶切除患者46例，男23例，女23例，年龄45～70岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ或Ⅱ级。随机分为两组：胸椎旁程控间歇注药组（P组）和持续静脉自控镇痛组（V组），每组25例。麻醉诱导前，P组超声引导下T4-5椎旁间隙穿刺置管后注入局麻药混合溶液20 ml（0.75%罗哌卡因15 ml+2%利多卡因5 ml），术后椎旁镇痛泵给予0.2%罗哌卡因；V组不予穿刺置管，术后静脉镇痛泵给予羟考酮0.8 mg/kg。记录术后1 h（T2）、4 h（T3）、24 h（T4）和48 h（T5）静息、咳嗽时NRS评分和Ramsay镇静评分；记录术后48 h内补救镇痛情况；记录术前（T0）、术后24 h（T4）、48 h（T5）的15项恢复质量评分量表（QoR-15）评分；记录术中舒芬太尼、瑞芬太尼和丙泊酚用量；术前（T0）、单肺通气结束时（T1）和术后24 h（T4）采集桡动脉血，采用AimPlex多因子流式检测技术检测血清IL-6、IL-10、TNF-α、IFN-γ浓度；记录术后48 h内爆发痛、恶心呕吐、心动过速、头晕等发生情况。
结果 与V组比较，T2、T4、T5时P组静息时NRS评分明显降低，T2—T5时P组咳嗽时NRS评分明显降低，T2、T3时P组Ramsay镇静评分明显降低，T4、T5时P组QoR-15评分明显增高，P组术中瑞芬太尼、舒芬太尼用量明显减少，T4时P组血清IL-6浓度明显降低，P组术后心动过速和头晕发生率明显降低（P＜0.05）。与T0时比较，T1时两组血清IL-6浓度、P组血清IL-10浓度明显升高，T4时两组血清IL-6、IL-10浓度明显升高（P<0.05）；与T1时比较，T4时两组血清IL-6、IL-10浓度明显升高（P＜0.05）。两组补救镇痛率差异无统计学意义。
结论 胸椎旁程控间歇脉冲注药可为胸腔镜肺叶切除患者提供满意的镇痛和镇静效果，提高患者早期恢复质量，减少术后不良反应的发生。
英文摘要:
      
Objective To explore the analgesic effect and early recovery quality of programmed intermittent bolus infusion in patients undergoing thoracoscopic lobectomy.
Methods Forty-six patients were selected for thoracoscopic lobectomy, 23 males and 23 females, aged 45-70 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ or Ⅱ. The patients were randomly divided into paravertebral programmed intermittent infusion group (group P) and continuous intravenous infusion group (group V), 25 patients in each group. Before anesthesia induction, patients in group P were injected with 20 ml of local anesthetic mixed solution after ultrasound guided T4-5 paravertebral space puncture and catheterization, and 0.2% ropivacaine was given by postoperative paravertebral analgesia pump. Patients in group V were not given puncture catheterization, and oxycodone 0.8 mg/kg hydrochloride injection was given by postoperative intravenous analgesia pump. NRS scores at rest and cough, and Ramsay scores were recorded 1, 4, 24, and 48 hours after surgery. Remedic analgesia was recorded within 48 hours after surgery. Quality of Recovery-15 score (QoR-15) was recorded before surgery and 24, 48 hours after surgery. Intraoperative amounts of sufentanil, remifentanil and propofol were recorded. The concentration of cytokines (IL-6, IL-10, TNF-α, IFN-γ) in serum was measured by AimPlex multifactor flow cytometry at preoperative (T0), the end of one lung ventilation (T1), and 24 hours postoperatively (T4). Adverse events such as pain, nausea and vomiting, tachycardia, and dizziness were recorded within 48 hours after operation.
Results Compared with group V, the NRS score at rest in group P was significantly at T2, T4, and T5, the NRS score at cough in group P was significantly reduced at T2-T5, the Ramsay sedation score in group P was significantly reduced at T2 and T3, and the QoR-15 score in group P was significantly increased at T4 and T5 (P < 0.05). Compared with group V, the dosage of remifentanil and sufentanil in group P was significantly reduced during operation, the serum IL-6 concentration in group P was significantly reduced at T4, and the incidence of postoperative tachycardia and dizziness in group P was significantly reduced (P < 0.05). Compared with T0, serum IL-6 concentration in the two groups and serum IL-10 concentration in group P were significantly increased at T1, serum IL-6 and IL-10 concentrations in the two groups were significantly increased at T4 (P < 0.05). Compared with T1, serum levels of IL-6 and IL-10 were increased significantly in the two groups at T4(P < 0.05). There was no significant difference in salvage analgesia rates between the two groups.
Conclusion Programmed paravertebral intermittent blous infusion can provide satisfactory analgesia and sedation after thoracoscopic surgery, improve the quality of early recovery of patients, and reduce the incidence of postoperative adverse reactions.
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