摘要
目的探讨右美托咪定联合超声引导下椎旁神经阻滞(PVNB)对胸腔镜肺癌根治术患者血流动力学、气管插管反应及炎症因子的影响。方法前瞻性选取2024年3月至2025年2月安徽省胸科医院收治的120例胸腔镜肺癌根治术患者为研究对象,采用随机数字表法将研究对象分为对照组和观察组,每组60例。两组患者均于麻醉诱导前给予超声引导下PVNB,观察组于阻滞后静脉泵注0.5μg/kg右美托咪定,对照组泵注等量生理盐水。比较分析两组患者插管前(T_(0))、插管后即刻(T_(1))、插管后3 min(T_(2))、插管后5 min(T_(3))的血流动力学水平[收缩压(SBP)、舒张压(DBP)、心率(HR)]。比较分析两组患者不同时刻的应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)]、气管插管情况、术后不良反应发生情况以及T_(0)、手术结束时(T_(4))时刻的炎症因子[C反应蛋白、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]。结果与T_(0)时刻比较,两组患者T_(1)、T_(2)、T_(3)时刻的SBP、DBP、HR水平均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。与T_(0)时刻比较,两组患者T_(3)时刻的E、NE水平均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者的气管插管反应发生率、术后咽喉疼痛发生率均低于对照组,差异有统计学意义(P<0.05)。与T_(0)时刻比较,两组患者T_(4)时刻的C反应蛋白、IL-6、TNF-α水平均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。结论右美托咪定联合超声引导下PVNB可维持胸腔镜肺癌根治术患者的血流动力学水平稳定,减轻患者的气管插管反应与炎症反应,同时减少术后不良事件的发生。
Objective To investigate the effect of dexmedetomidine combined with ultrasound-guided paravertebral nerve block(PVNB)on hemodynamics,tracheal intubation response and infl ammatory factors in patients undergoing thoracoscopic radical resection of lung cancer.Method A total of 120 patients who underwent thoracoscopic radical resection of lung cancer in Anhui Provincial Chest Hospital from March 2024 to February 2025 were prospectively selected as the research objects.They were divided into the control group and the observation group by the random number table method,with 60 cases in each group.Two groups were given ultrasound-guided PVNB before anesthesia induction.The observation group was intravenously pumped with 0.5μg/kg dexmedetomidine after block,while the control group was pumped with the same amount of normal saline.The hemodynamic levels(SBP,DBP,HR)before intubation(T_(0)),immediately after intubation(T_(1)),3 minutes after intubation(T_(2)),and 5 minutes after intubation(T_(3))in the two groups were compared and analyzed.The stress response indicators(E,NE)at different times,tracheal intubation situation,postoperative adverse reactions and infl ammatory factors(CRP,IL-6,TNF-α)at T_(0),the end of surgery(T_(4))in the two groups were compared and analyzed.Result Compared with time T_(0),the levels of SBP,DBP and HR in two groups at T_(1),T_(2),T_(3) increased,but the observation group was lower than the control group,and the differences were statistically signifi cant(P<0.05).Compared with T_(0),the levels of E,NE in two groups increased at T_(3),but the observation group was lower than the control group,and the differences were statistically signifi cant(P<0.05).The incidences of tracheal intubation response and postoperative sore throat in the observation group were lower than those in the control group,and the differences were statistically signifi cant(P<0.05).Compared with T_(0),the levels of CRP,IL-6 and TNF-αin two groups increased at T_(4),but the observation group was lower than the control group,and the differences were statistically signifi cant(P<0.05).Conclusion Dexmedetomidine combined with ultrasound-guided PVNB can maintain the hemodynamic level stability of patients undergoing thoracoscopic radical resection of lung cancer,and reduce the tracheal intubation response and infl ammation response,and simultaneously reduce the occurrence of postoperative adverse events.
作者
李若男
孔婧
姚晶曼
朱峰
胡友洋
Li Ruonan;Kong Jing;Yao Jingman;Zhu Feng;Hu Youyang(Department of Anesthesiology,Anhui Provincial Chest Hospital,Hefei Anhui 230022,China)
出处
《中国医刊》
2026年第2期171-175,共5页
Chinese Journal of Medicine
基金
安徽省卫生健康科研项目(2024BAc20083)。
关键词
肺癌
椎旁神经阻滞
右美托咪定
气管插管反应
炎症因子
Lung cancer
Paravertebral nerve block
Dexmedetomidine
Tracheal intubation response
Infl ammatory factors
