摘要
目的 分析对乙酰氨基酚超前镇痛复合肋间神经阻滞在胸腔镜肺叶切除术中的应用效果。方法 选取2021年1月至2023年9月六安市中医院收治的120例经胸腔镜行肺叶切除术的肺癌患者作为研究对象,按随机数字表法将其分为对照组和观察组,每组60例。对照组患者于麻醉诱导前给予对乙酰氨基酚超前镇痛,观察组患者在对照组的基础上复合肋间神经阻滞。比较2组患者术后3、12、24、48 h的视觉模拟量表(VAS)评分、Ramsay镇静评分及血清β-内啡肽、前列腺素E2水平;比较2组患者麻醉诱导前、拔管后的去甲肾上腺素(NE)、肾上腺素(E)、血清皮质醇(Cor)等应激反应指标及CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)等免疫功能指标;比较2组患者拔管后不良反应的发生情况。结果 2组患者术后VAS评分随时间延长逐渐增加,Ramsay镇静评分随时间延长逐渐降低,观察组患者术后各时点VAS评分均低于对照组,Ramsay镇静评分均高于对照组,差异均有统计学意义(P<0.05)。2组患者术后血清β-内啡肽、前列腺素E2水平随时间延长逐渐降低,观察组患者术后各时点血清β-内啡肽水平均高于对照组,前列腺素E2水平均低于对照组,差异均有统计学意义(P<0.05)。2组患者拔管后NE、E、Cor水平均显著降低(P<0.05),且观察组低于对照组(P<0.05);2组患者拔管后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均显著降低(P<0.05),且观察组高于对照组(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 对乙酰氨基酚超前镇痛复合肋间神经阻滞应用于胸腔镜肺叶切除术,患者镇痛和镇静效果良好,有助于提高患者免疫功能,减少术后不良反应。
Objective To analyze the application effect of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy.Methods A total of 120 patients with lung cancer who underwent thoracoscopic lobectomy admitted to Lu'an Traditional Chinese Medicine Hospital from January 2021 to September 2023 were selected as the study objects,and they were divided into the control group and the observation group according to random number table method,with 60 cases in each group.Patients in the control group were given acetaminophen preemptive analgesia before anesthesia induction,while patients in the observation group were given intercostal nerve block on the basis of the control group.The visual analogue scale(VAS)score,Ramsay sedation score,serumβ-endorphin level and prostaglandin E2 level 3,12,24 and 48 hours after operation of patients in the two groups were compared.The stress response indexes such as norepinephrine(NE),epinephrine(E)and serum cortisol(Cor),as well as immune function indexes such as CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)before anesthesia induction and after extubation of patients in the two groups were compared.The incidence of adverse reactions after extubation of patients in the two groups were compared.Results The VAS scores of patients after surgery in the two groups gradually increased with time,and the Ramsay sedation scores gradually decreased with time.The VAS scores of patients in the observation group were lower than those in the control group at each postoperative time point,and the Ramsay sedation scores were higher than those in the control group,with statistically significant differences(P<0.05).The levels of serumβ-endorphin and prostaglandin E2 of patients after surgery in the two groups gradually decreased with time.The levels of serumβ-endorphin of patients at each postoperative time point in the observation group were higher than those in the control group,and the levels of prostaglandin E2 of patients at each postoperative time point in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The levels of NE,E,and Cor after extubation of patients in the two groups were significantly decreased(P<0.05),and those in the observation group were lower than those in the control group(P<0.05).The levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)after extubation of patients in the two groups were significantly decreased(P<0.05),and those in the observation group were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).Conclusion The application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy has good analgesic and sedative effects on patients,which is helpful to improve patients'immune function and reduce postoperative adverse reactions.
作者
卜乐晔
马启刚
张传鑫
何光耀
BU Le-ye;MA Qi-gang;ZHANG Chuan-xin;HE Guang-yao(Department of Anesthesiology,Lu'an Traditional Chinese Medicine Hospital,Lu'an Anhui 237000,China)
出处
《局解手术学杂志》
2025年第2期159-163,共5页
Journal of Regional Anatomy and Operative Surgery
基金
中国红十字基金会医学赋能公益专项基金项目(CRCF-YXFN-202302059)。
