超声引导下胸椎旁神经阻滞在单孔胸腔镜下肺叶切除术患者中的应用效果

doi:10.3760/cma.j.cn441417-20240905-03016

摘要/Abstract

摘要：

目的　探究超声引导下胸椎旁神经阻滞（TPVB）在单孔胸腔镜下肺叶切除术患者中的应用效果。方法　选取2021年3月至2023年3月威海市立医院收治的100例行单孔胸腔镜下肺叶切除术的肺癌患者作为研究对象。采用随机数字表法，将患者分为对照组和研究组，各50例。对照组男29例，女21例；年龄（58.71±7.53）岁；体重指数（22.13±1.69）kg/m²；肿瘤长径（2.35±1.06）cm；病理类型：鳞癌22例，腺癌26例，腺鳞癌2例。研究组男31例，女19例；年龄（59.54±7.81）岁；体重指数（22.06±1.83）kg/m²；肿瘤长径（2.39±1.17）cm；病理类型：鳞癌25例，腺癌22例，腺鳞癌3例。对照组采用胸段硬膜外麻醉，研究组采用超声引导下TPVB。比较两组术中基本情况（手术时长、麻醉时长、术中补液量、术中舒芬太尼用量、血管活性药物使用情况、尿量、失血量），术后6、12、24、36、48、72 h静态（安静状态）和动态（深呼吸）疼痛程度［视觉模拟评分法（VAS）］，入室后及术后24、48 h血清细胞因子水平［单核细胞趋化蛋白-1（MCP-1）、前列腺素E2（PGE2）、肿瘤坏死因子α（TNF-α）］、肺功能指标［第1秒用力呼气容积（FEV1）、肺活量（VC）、最大呼气中段流量（MMF）、最大通气量（MVV）］。采用重复测量方差分析、独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　研究组麻醉时长短于对照组［（96.09±17.42）min比（141.42±19.51）min］，且使用血管活性药物占比低于对照组［2.00%（1/50）比18.00%（9/50）］（均P<0.05）。术后6、12、24、36、48、72 h，研究组静态、动态VAS评分均低于对照组（均P<0.05）。术后24、48 h，研究组血清MCP-1、PGE2和TNF-α水平均低于对照组［（60.34±7.01）ng/L比（69.50±7.54）ng/L、（49.41±7.63）ng/L比（58.65±7.22）ng/L，（372.40±36.74）ng/L比（388.52±39.08）ng/L、（293.96±35.80）ng/L比（322.85±33.78）ng/L，（37.80±5.02）ng/L比（55.23±6.45）ng/L、（36.81±4.88）ng/L比（45.73±5.24）ng/L］（均P<0.05）；研究组FEV1、VC、MMF、MVV均大于对照组［（2.05±0.62）L比（1.57±0.71）L、（2.74±0.52）L比（1.99±0.38）L，（2.24±0.63）L比（1.85±0.52）L、（2.84±0.45）L比（2.21±0.40）L，（1.57±0.73）L/s比（0.96±0.51）L/s、（2.10±0.32）L/s比（1.81±0.27）L/s，（62.29±8.23）L比（58.77±8.09）L、（69.31±5.45）L比（66.74±6.03）L］（均P<0.05）。术后3 d内，两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　超声引导下TPVB可有效降低行单孔胸腔镜下肺叶切除术的肺癌患者术后疼痛程度和血清MCP-1、PGE2、TNF-α水平，有助于肺功能恢复，安全性较好。

关键词:

超声引导, 胸椎旁神经阻滞, 疼痛程度, 肺功能, 肺叶切除, 单孔胸腔镜

Abstract:

Objective　To explore the application effect of ultrasound-guided thoracic paravertebral nerve block (TPVB) in patients undergoing thoracoscopic lobectomy. Methods　A total of 100 patients with lung cancer who underwent single-hole thoracoscopic lobectomy in Weihai Municipal Hospital from March 2021 to March 2023 were selected as the study objects and were divided into a control group and a study group with 50 cases in each group by the random number table method. There were 29 males and 21 females in the control group, aged (58.71±7.53) years; the body mass index was (22.13±1.69) kg/m²; the tumor length was (2.35±1.06) cm; the pathological types were: 22 cases of squamous cell carcinoma, 26 cases of adenocarcinoma, and 2 cases of adeno-squamous cell carcinoma. There were 31 males and 19 females in the study group, aged (59.54±7.81) years; the body mass index was (22.06±1.83) kg/m²; the tumor length was (2.39±1.17) cm; the pathological types were: 25 cases of squamous cell carcinoma, 22 cases of adenocarcinoma, and 3 cases of adeno-squamous cell carcinoma. The control group underwent thoracic epidural anesthesia, and the study group underwent ultrasound-guided TPVB. The basic conditions (operation time, anesthesia time, intraoperative fluid infusion volume, intraoperative sufentanil dosage, use of vasoactive drugs, urine volume, and blood loss), static (quiet state) and dynamic (deep breathing) pain degrees [Visual Analogue Scale (VAS)] 6, 12, 24, 36, 48, and 72 h after surgery, and serum cytokine levels [monocyte chemotactic protein-1 (MCP-1), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α)] and pulmonary function indicators [forced expiratory volume in the first second (FEV1), vital capacity (VC), maximum mid-expiratory flow (MMF), and maximum ventilatory volume (MVV)] after entry and 24 and 48 h after surgery were compared between the two groups. Repeated measure ANOVA, independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The duration of anesthesia in the study group was shorter than that in the control group [(96.09±17.42) min vs. (141.42±19.51) min], and the proportion of use of vasoactive drugs was lower than that in the control group [2.00% (1/50) vs. 18.00% (9/50)] (both P<0.05). At 6, 12, 24, 36, 48, and 72 h after surgery, the static and dynamic VAS scores of the study group were lower than those of the control group (all P<0.05). At 24 and 48 h after surgery, serum levels of MCP-1, PGE2, and TNF-α in the study group were lower than those in the control group [(60.34±7.01) ng/L vs. (69.50±7.54) ng/L, (49.41±7.63) ng/L vs. (58.65±7.22) ng/L, (372.40±36.74) ng/L vs. (388.52±39.08) ng/L, (293.96±35.80) ng/L vs. (322.85±33.78) ng/L, (37.80±5.02) ng/L vs. (55.23±6.45) ng/L, (36.81±4.88) ng/L vs. (45.73±5.24) ng/L] (all P<0.05); the FEV1, VC, MMF, and MVV in the study group were higher than those in the control group [(2.05±0.62) L vs. (1.57±0.71) L, (2.74±0.52) L vs. (1.99±0.38) L, (2.24±0.63) L vs. (1.85±0.52) L, (2.84±0.45) L vs. (2.21±0.40) L, (1.57±0.73) L/s vs. (0.96±0.51) L/s, (2.10±0.32) L/s vs. (1.81±0.27) L/s, (62.29±8.23) L vs. (58.77±8.09) L, (69.31±5.45) L vs. (66.74±6.03) L] (all P<0.05). Within 3 d after surgery, there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Ultrasound-guided TPVB can effectively reduce the pain degree and the levels of serum MCP-1, PGE2, and TNF-α of lung cancer patients undergoing single-port thoracoscopic lobectomy, which is conducive to the rapid recovery of lung function and has certain safety.

Key words:

Ultrasound guidance, Thoracic paravertebral nerve block, Degree of pain, Lung function, Pulmonary lobectomy, Single-hole thoracoscope

韩冰王星赵斌邓传军刘宽.

超声引导下胸椎旁神经阻滞在单孔胸腔镜下肺叶切除术患者中的应用效果 [J]. 国际医药卫生导报, 2025, 31(3): 429-434.

Han Bing, Wang Xing, Zhao Bin, Deng Chuanjun, Liu Kuan.

Application of ultrasound-guided thoracic paravertebral nerve block in patients undergoing thoracoscopic lobectomy [J]. International Medicine and Health Guidance News, 2025, 31(3): 429-434.

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