Abstract:

Objective　To evaluate the effects of continuous thoracic paravertebral block (CTPVB) with ropivacaine on cognitive function, analgesia, and inflammatory factors in patients undergoing video-assisted thoracoscopic lobectomy. Methods　This study was a randomized controlled trial. A total of 80 patients with non-small cell lung cancer who underwent video-assisted thoracoscopic lobectomy in Xi'an Central Hospital from January to December 2023 were selected as the study objects, and were divided into a control group (40 cases) and a study group (40 cases) according to the envelope method. There were 24 males and 16 females in the control group, aged (43.24±5.79) years, American Society of Anesthesiologists (ASA) grade Ⅰ in 16 cases and grade Ⅱ in 24 cases, and the pathological stages of Ⅰa, Ⅰb, Ⅱa, Ⅱb, and Ⅲa were 15, 11, 6, 5, and 3 cases, respectively. There were 22 males and 18 females in the study group, aged (44.13±5.62) years, ASA grade Ⅰ in 17 cases and grade Ⅱ in 23 cases, and the pathological stages of Ⅰa, Ⅰb, Ⅱa, Ⅱb, and Ⅲa were 14, 13, 5, 6, and 2 cases, respectively. The control group was given general anesthesia, and the study group was given CTPVB with ropivacaine (before anesthesia induction, CTPVB on the affected side was guided by ultrasound, the probe was located parallel to the intercostal space for puncture points, the intraplane puncture method was used to reach T4 - T8 segments, 5 ml of 0.5% ropivacaine was injected into each paravertebral space, and the nerve block effect was determined by the method of skin pain attenuation by acupuncture. General anesthesia was performed 15 min after CTPVB took effect) combined with general anesthesia. Postoperative recovery, cognitive function [Mini-Mental State Examination (MMSE)], pain levels at rest and during coughing [Visual Analogue Scale (VAS)], analgesia, levels of inflammatory factors [interleukin (IL-6), IL-8, and tumor necrosis factor-α (TNF-α)], and occurrence of adverse reactions were compared between the two groups. χ² and t tests were used for statistical analysis. Results　The postoperative recovery of the study group was superior to the control group [extubation time: (19.95±7.83) min vs. (26.36±8.02) min, awakening time: (10.96±6.78) min vs. (21.53±9.24) min, postoperative ICU stay: (52.85±10.23) min vs. (61.31±10.13) min], with statistically significant differences (all P<0.05). At 24 h after surgery, the MMSE score of the study group was (26.55±2.42) points, which was higher than that of the control group [(24.30±2.52) points], with a statistically significant difference (P<0.05). At 1 h, 6 h, and 12 h after surgery, the VAS scores of the study group at rest and during coughing were lower than those of the control group (all P<0.05). The analgesia of the study group was superior to the control group [propofol dosage: (582.68±75.31) mg vs. (674.74±80.95) mg, fentanyl dosage: (209.86±28.74) µg vs. (347.43±30.58) µg, first analgesic pump press time: (11.13±4.86) h vs. (7.94±5.38) h, number of analgesic pump presses: (2.35±0.86) times vs. (4.25±1.35) times] (all P<0.05). The levels of IL-6, IL-8, and TNF-α in the study group were lower than those in the control group 24 h and 48 h after surgery (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the study group and the control group [32.50% (13/40) vs. 47.50% (19/40)] (P>0.05). Conclusion　CTPVB with ropivacaine significantly improves postoperative cognitive function and analgesic effect, and reduces systemic inflammatory responses induced by surgery, indicating that this anesthetic method positively impacts postoperative recovery.

Key words:

Continuous thoracic paravertebral block, Ropivacaine, Video-assisted thoracoscopic lobectomy, Cognitive function, Analgesic effect,  , Inflammatory factors

摘要：

目的　评估罗哌卡因连续胸椎旁神经阻滞（CTPVB）对胸腔镜肺叶切除术患者认知功能、镇痛效果及炎症因子的影响。方法　本研究为随机对照试验。选取2023年1月至12月西安市中心医院行胸腔镜肺叶切除术的80例非小细胞肺癌患者作为研究对象，按信封法分为对照组（40例）和研究组（40例）。对照组男24例，女16例；年龄（43.24±5.79）岁；美国麻醉医师协会（ASA）分级Ⅰ级16例，Ⅱ级24例；病理分期Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa期各15、11、6、5、3例。研究组男22例，女18例；年龄（44.13±5.62）岁；ASA分级Ⅰ级17例，Ⅱ级23例；病理分期Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa期各14、13、5、6、2例。对照组给予全身麻醉，研究组给予罗哌卡因CTPVB（麻醉诱导前在超声引导下行患侧CTPVB，探头平行于肋间隙行穿刺点定位，使用平面内穿刺法至T4～T8节段，在各椎旁间隙注射0.5%罗哌卡因5 ml，用针刺皮肤痛觉消退法确定神经阻滞效果，CTPVB起效15 min后开始全身麻醉）联合全身麻醉。比较两组患者术后恢复情况、认知功能［简易智力状态检查量表（MMSE）］、静息和咳嗽时的疼痛程度［视觉模拟评分法（VAS）］、镇痛情况、炎症因子［白细胞介素（IL）-6、IL-8、肿瘤坏死因子-α（TNF-α）］水平、不良反应发生情况。采用χ²、t检验进行统计学分析。结果　研究组术后恢复情况优于对照组［拔管时间：（19.95±7.83）min比（26.36±8.02）min、苏醒时间：（10.96±6.78）min比（21.53±9.24）min、术后监护室停留时间：（52.85±10.23）min比（61.31±10.13）min］，差异均有统计学意义（均P<0.05）。术后24 h，研究组MMSE评分为（26.55±2.42）分，高于对照组的（24.30±2.52）分，差异有统计学意义（P<0.05）。术后1 h、6 h、12 h，研究组在静息及咳嗽状态下的VAS评分均低于对照组（均P<0.05）。研究组镇痛情况优于对照组［丙泊酚用量：（582.68±75.31）mg比（674.74±80.95）mg、芬太尼用量：（209.86±28.74）µg比（347.43±30.58）µg、首次按压镇痛泵时间：（11.13±4.86）h比（7.94±5.38）h、镇痛泵按压次数：（2.35±0.86）次比（4.25±1.35）次］（均P<0.05）。术后24 h、48 h，研究组IL-6、IL-8、TNF-α水平均低于对照组（均P<0.05）。研究组不良反应发生率与对照组比较［32.50%（13/40）比47.50%（19/40）］，差异无统计学意义（P>0.05）。结论　罗哌卡因CTPVB可改善胸腔镜肺叶切除术患者的术后认知功能、镇痛效果，减轻手术引起的全身炎症反应，对术后恢复有积极影响。

关键词:

连续胸椎旁神经阻滞, 罗哌卡因, 胸腔镜肺叶切除术, 认知功能, 镇痛效果, 炎症因子