超前镇痛技术对改善胸腔镜下肺癌根治术呼吸功能及应激状态的影响研究

doi:10.3760/cma.j.issn.1007-1245.2023.24.008

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (24): 3561-3565.DOI: 10.3760/cma.j.issn.1007-1245.2023.24.008

超前镇痛技术对改善胸腔镜下肺癌根治术呼吸功能及应激状态的影响研究

王文燕¹ 张沛重²

¹南阳医学高等专科学校第一附属医院静脉用药调配中心，南阳　473000；²南阳医学高等专科学校第一附属医院麻醉与围术期医学科，南阳　473000

收稿日期:2023-06-30 出版日期:2023-12-15 发布日期:2024-01-04
通讯作者: 王文燕，Email：wangwenya19892023@126.com
基金资助:
河南省医学科技攻关项目（LHGJ202012217）

Effect of advanced analgesia in improvement of respiratory function and stress state in patients taking thoracoscopic radical resection of lung cancer

Wang Wenyan¹, Zhang Peizhong²

¹Intravenous Drug Formulation Center, First Hospital, Nanyang Medical College, Nanyang 473000, China; ²Department of Anesthesia and Perioperative Medicine, First Hospital, Nanyang Medical College, Nanyang 473000, China

Received:2023-06-30 Online:2023-12-15 Published:2024-01-04
Contact: Wang Wenyan, Email: wangwenya19892023@126.com
Supported by:
Problem-tackling Project of Medical Science and Technology in Henan (LHGJ202012217)

摘要/Abstract

摘要：

目的　观察超前镇痛技术对改善胸腔镜下肺癌根治术呼吸功能及应激状态的影响。方法　本研究为前瞻性研究，选取2021年1月至2022年12月南阳医学高等专科学校第一附属医院接受肺癌根治术治疗的126例患者为研究对象，经电脑随机分组法将患者分为常规组（63例）和试验组（63例）。常规组中男40例，女23例，年龄（55.18±5.27）岁，予以常规麻醉及镇痛干预；试验组中男43例，女20例，年龄（56.35±5.22）岁，予以超前镇痛技术辅助麻醉。比较两组患者的镇痛效果，术前术后呼吸功能，应激反应。采用χ²检验、t检验进行统计比较。结果　试验组术后3 h的疼痛视觉模拟量表（VAS）评分为（4.24±1.35）分，术后6 h为（3.71±0.26）分，术后12 h为（2.88±0.24）分，均低于常规组［（5.31±1.47）分、（4.42±1.25）分、（3.35±0.27）分］，差异均有统计学意义（均P<0.05）。试验组术后自控镇痛泵（PCIA）按压次数为（2.28±0.36）次/h，麻醉恢复室（PACU）停留时间为（85.45±10.24）min，PCIA停用时间为（20.35±5.41）h，均低于常规组［（4.24±1.33）次/h、（93.36±10.27）min、（23.39±5.18）h］，差异均有统计学意义（均P<0.05）。术前，两组患者的呼吸功能、应激反应比较，差异均无统计学意义（均P>0.05）；术后，试验组的呼吸频率（RR）为（16.44±5.14）次/min，呼气峰值流速（PEF）为（472.55±50.69）L/min，第1秒用力呼气容积百分比（FEV1）为（81.15±10.36）%，均高于常规组［（13.31±5.22）次/min、（433.75±50.58）L/min、（75.33±10.27）%］，差异均有统计学意义（均P<0.05）。术后，试验组的去甲肾上腺素（NE）为（170.33±20.46）ng/L，皮质醇（Cor）为（231.45±30.61）μg/L，均低于常规组［（185.33±20.72）ng/L、（252.45±30.63）μg/L］，超氧化物歧化酶（SOD）为（275.25±50.66）U/ml，高于常规组（231.45±50.33）U/ml，差异均有统计学意义（均P<0.05）。结论　在肺癌根治术麻醉中实施超前镇痛技术能有效增强镇痛效果，对改善患者呼吸功能、减轻应激反应均有积极意义。

关键词:

肺癌, 根治术, 超前镇痛, 镇痛效果, 呼吸功能, 应激状态

Abstract:

Objective　To observe the effect of advanced analgesia in the improvement of respiratory function and stress state in patients taking thoracoscopic radical resection of lung cancer. Methods　One hundred and twenty-six patients who underwent radical lung cancer surgery at First Hospital, Nanyang Medical College from January 2021 to December 2022 were selected as the study objects. The patients were divided into a conventional group (63 cases) and an experimental group (63 cases) by the computer randomization method. There were 40 males and 23 females in the conventional group; they were (55.18±5.27) years old. There were 43 males and 20 females in the experimental group; they were (56.35±5.22) years old. The conventional group received routine anesthesia and analgesic intervention, while the experimental group received advanced analgesic technology assisted anesthesia. The analgesic effects and respiratory function and stress response before and after the surgery were compared between the two groups. χ² and t tests were applied. Results　The scores of Visual Analogue Scale (VAS) 3, 6, and 12 h after the surgery in the experimental grop were lower than those in the conventional group [(4.24±1.35) vs. (5.31±1.47), (3.71±0.26) vs. (4.42±1.25), and (2.88±0.24) vs. (3.35±0.27)], with statistical differences (all P<0.05). The number using postoperative patient-controlled analgesia pump (PCIA), time staying in the anesthesia recovery room (PACU), and PCIA discontinuation time in the experimental group were shorter than those in the conventional group [(2.28±0.36) times/h vs. (4.24±1.33) times/h, (85.45±10.24) min vs. (93.36±10.27) min, and (20.35±5.41) h vs. (23.39±5.18) h], with statistical differences (all P<0.05). Before the surgery, there were no statistical difference in respiratory function and stress response between the two groups (all P>0.05); after the surgery, the respiratory rate (RR), peak expiratory flow rate (PEF), and forced expiratory volume in the first second (FEV1) in the experimental group were higher than those in the conventional group [(16.44±5.14) beats/min vs. (13.31±5.22) beats/min, (472.55±50.69) L/min vs. (433.75±50.58) L/min, and (81.15±10.36)% vs. (75.33±10.27)%], with statistical differences (all P<0.05). After the surgery, the levels of norepinephrine (NE) and cortisol (Cor) in the experimental group were lower than those in the conventional group [(170.33±20.46) ng/L vs. (185.33±20.72) ng/L and (231.45±30.61) μg/L vs. (252.45±30.63) μg/L], and the superoxide dismutase (SOD) level was and higher than that in the conventional group [(275.25±50.66) U/ml vs. (231.45±50.33) U/ml], with statistical differences (all P<0.05). Conclusion　The implementation of advanced analgesia technology in the anesthesia for patients taking lung cancer radical surgery can effectively enhance the analgesic effect, and has positive significance in improving their respiratory function and reducing their stress response.

Key words:

Lung cancer, Radical resection, Advanced analgesia, Analgestic , effect, Respiratory function, Stress state

王文燕张沛重.

超前镇痛技术对改善胸腔镜下肺癌根治术呼吸功能及应激状态的影响研究 [J]. 国际医药卫生导报, 2023, 29(24): 3561-3565.

Wang Wenyan, Zhang Peizhong.

Effect of advanced analgesia in improvement of respiratory function and stress state in patients taking thoracoscopic radical resection of lung cancer [J]. International Medicine and Health Guidance News, 2023, 29(24): 3561-3565.

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超前镇痛技术对改善胸腔镜下肺癌根治术呼吸功能及应激状态的影响研究

Effect of advanced analgesia in improvement of respiratory function and stress state in patients taking thoracoscopic radical resection of lung cancer

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