文章摘要
胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后痛觉过敏的影响
Effect of thoracic paravertebral block on postoperative hyperalgesia in patients undergoing thoracoscopic radical resection of lung cancer
  
DOI：10.12089/jca.2022.01.004
中文关键词: 胸椎旁神经阻滞  术后痛觉过敏  阿片类药物  肺癌根治术
英文关键词: Thoracic paravertebral block  Postoperative hyperalgesia  Opioids  Radical resection of lung cancer
基金项目:
作者单位E-mail
陈秀茹 350000,福州市,福建医科大学附属协和医院麻醉科  
林尧 350000,福州市,福建医科大学附属协和医院麻醉科  
吴碧玲 350000,福州市,福建医科大学附属协和医院麻醉科  
陈文华 350000,福州市,福建医科大学附属协和医院麻醉科  
张良成 350000,福州市,福建医科大学附属协和医院麻醉科  
林鹏焘 350000,福州市,福建医科大学附属协和医院麻醉科 pengtaolin2003@163.com 
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中文摘要:
      
目的 观察胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后痛觉过敏的影响。
方法 选择行单孔胸腔镜肺癌根治术患者60例，男27例，女33例，年龄18～75岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：对照组（C组）和全麻联合胸椎旁神经阻滞组（T组），每组30例。麻醉诱导前，T组于T4-5、T6-7椎旁间隙各注射0.33%罗哌卡因15 ml；C组于相同位置注射等容量生理盐水。两组术中均予七氟醚、瑞芬太尼全身麻醉。术前24 h及术后24、48 h采用Von Frey纤毛测量机械痛阈。记录术后0.5、1、2、6、12、24、48 h 数字评价量表（NRS）评分。记录术中七氟醚、瑞芬太尼用量、PACU停留时间及PACU补救镇痛例数。记录术后24 h内镇痛泵用量及镇痛泵有效按压次数。记录术后首次按压镇痛泵时间及患者镇痛效果满意情况。记录术后48 h内恶心、呕吐、镇静过度、低氧血症、低血压等不良反应的发生情况。
结果 术后24、48 h T组机械痛阈明显高于C组（P＜0.05）。术后0.5、1、2、6、12 h T组静息和活动时NRS评分明显低于C组（P＜0.05）。T组术中瑞芬太尼用量、术后24 h内镇痛泵用量及镇痛泵有效按压次数明显少于C组，PACU停留时间明显短于C组，PACU补救镇痛率明显低于C组（P＜0.05）。T组首次按压镇痛泵时间明显长于C组，术后患者镇痛效果满意率明显高于C组（P＜0.05）。两组术后不良反应发生率差异无统计学意义。
结论 胸椎旁神经阻滞可以缓解胸腔镜肺癌根治术患者术后痛觉过敏，减少术中及术后阿片类药物用量，提高患者对术后镇痛效果的满意率。
英文摘要:
      
Objective To observe the effect of thoracic paravertebral block (TPVB) on postoperative hyperalgesia in patients undergoing thoracoscopic radical resection of lung cancer.
Methods Sixty patients scheduled for single-incision thoracoscopic radical resection of lung cancer, 27 males and 33 females, aged 18-75 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into the following two groups by random number table method: control group (group C) and general anesthesia combined with TPVB group (group T), 30 patients in each group. TPVB in T4-5 and T6-7 thoracic paravertebral spaces were implemented before the induction of general anesthesia in group T, while 0.33% ropivacaine 15 ml were injected into each thoracic paravertebral space. The same amount of normal saline was injected into the same thoracic paravertebral spaces in group C. Subsequently, all patients underwent general anesthesia by sevoflurane and remifentanil. Mechanical pain thresholds were measured using Von Frey filaments 24 hours before surgery, 24 and 48 hours after surgery. Numerical rating scale (NRS) scores were recorded at 0.5, 1, 2, 6, 12, 24, and 48 hours postoperatively. Other variables, including intraoperative dosage of sevoflurane and remifentanil, post-anesthesia care unit (PACU) retention time, number of rescue analgesia in PACU, cumulative consumption of analgesic pump liquid, number of effective pressing of analgesic pump within 24 hours postoperatively, first time of pressing analgesic pumps, and patient satisfaction regarding postoperative analgesia were recorded. Adverse reactions such as nausea, vomiting, excessive sedation, hypoxemia and hypotension were recorded within 48 hours after operation.
Results Mechanical pain thresholds in group T were higher than those in group C 24 and 48 hours after surgery (P < 0.05). NRS scores in group T were lower than those in group C 0.5, 1, 2, 6, 12 hours after surgery, no matter in motion or at rest (P < 0.05). Compared with group C, total consumption of intraoperative dosage of remifentanil, PACU retention time, number of rescue analgesia, cumulative consumption of analgesic pump liquid and analgesic pump effective pressing times within 24 hours postoperatively were less in group T (P < 0.05). The first time of pressing the analgesia pump was later in group T than in group C (P < 0.05). Patient satisfaction regarding postoperative analgesia was higher in group T than in group C (P < 0.05). With respect to adverse effects up to 48 hours postoperatively, differences between the two groups were not significant.
Conclusion TPVB can alleviate postoperative hyperalgesia in patients who underwent thoracoscopic radical resection of lung cancer, reduce perioperative opioids consumption, and further improve patient satisfaction regarding postoperative analgesia.
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