Abstract:

Objective　To explore the effect of nalbuphine combined with rhomboid intercostal block (RIB) on acute hyperalgesia after video-assisted thoracoscopic lobectomy. Methods　A total of 96 patients with non-small cell lung cancer who underwent video-assisted thoracoscopic lobectomy in Hanzhong Central Hospital from February 2021 to March 2023 were prospectively selected and were divided into group A, B, and C with 32 cases in each group by the random number table method. Group A included 18 males and 14 females, aged (64.25±7.41) years. Group B included 20 males and 12 females, aged (64.89±7.56) years. Group C included 16 males and 16 females, aged (65.18±7.20) years. Group C received RIB under ultrasound guidance before anesthesia induction, and group B and C received intravenous injection with 2 ml of nalbuphine 3 minutes before anesthesia induction, while group A received an equal amount of normal saline intravenously. The intraoperative medication, postoperative recovery, pain, mechanical pain threshold, stress response, immune function, hemodynamics, adverse reactions, and complications were compared among the three groups. One-way ANOVA, repeated measure ANOVA, LSD-t test, and χ² test were used. Results　The dosage of propofol, dosage of remifentanil, rescue analgesia rate, and usage rate of vasoactive drugs in group C were lower than those in group A and B, and those in group B were lower than those in group A (all P<0.05). There were no statistically significant differences in the hospital stay, time of first standing, time of first food intake, or total incidence of complications and adverse reactions among the three groups (all P>0.05). The mechanical pain thresholds around the incision and inside forearm of the three groups 6 h and 48 h after surgery were lower than those before surgery, and those 48 h after surgery were higher than those 6 h after surgery (all P<0.05); those in group C were higher than those in group A and B 6 h and 48 h after surgery [(76.25±7.03) g vs. (41.31±5.22) g and (58.06±6.10) g, (81.19±8.24) g vs. (63.44±6.38) g and (76.30±7.21) g, (85.39±7.01) g vs. (72.06±5.23) g and (79.24±6.15) g, (95.07±8.36) g vs. (79.43±6.28) g and (87.31±7.12) g], those in group B were higher than those in group A 6 h and 48 h after surgery, with statistically significant differences (all P<0.05). The VAS scores of the three groups 48 h after surgery were lower than those of the same group 1 h and 6 h after surgery, and those 6 h after surgery were lower than those of the same group 1 h after surgery. The VAS scores of group C 1 h, 6 h, and 48 h after surgery were lower than those of group A and B, and those of group B were lower than those of group A (all P<0.05). Twenty-four hours after surgery, the levels of serum cortisol, adrenocorticotropic hormone, and norepinephrine in the three groups were higher than those before surgery, those in group C were lower than group A and B, and those in group B were lower than those in group A (all P<0.05). Twenty-four hours after surgery, the levels of CD3+ and CD4+ in the three groups were lower than those before surgery, the levels in group C were higher than those in group A and B, and the levels in group B were higher than those in group A (all P<0.05). At the end of anesthesia (T2), the heart rate and mean arterial pressure of the three groups were lower than those 5 min after anesthesia induction (T1), but were higher than those 5 min before anesthesia induction (T0), and those of the three groups at T1 were higher than those at T0 (all P<0.05); those of group C were lower than group A and B, and those of group B were lower than those of A group at T1 and T2 (all P<0.05). Conclusion　Nalbuphine combined with RIB can inhibit acute hyperalgesia after video-assisted thoracoscopic lobectomy, improve the immune function, reduce the anesthesia drug usage during surgery, alleviate the postoperative pain and stress response, and maintain the hemodynamic stability, which is safe and reliable.

Key words:

Nalbuphine, Rhomboid intercostal block, Video-assisted thoracoscopy, Pulmonary lobectomy, Acute hyperalgesia, Safety

摘要：

目的　探讨纳布啡联合菱形肌-肋间肌阻滞（RIB）抑制电视胸腔镜肺叶切除术后急性痛觉过敏的效果。方法　前瞻性选择2021年2月至2023年3月在汉中市中心医院接受电视胸腔镜肺叶切除术的非小细胞肺癌患者96例，按照随机数字表法分为A、B、C组，各32例。A组男18例，女14例，年龄（64.25±7.41）岁；B组男20例，女12例，年龄（64.89±7.56）岁；C组男16例，女16例，年龄（65.18±7.20）岁。C组麻醉诱导前于超声引导下行菱形肌-肋间肌阻滞；麻醉诱导前3 min，A组静脉注射2 ml生理盐水，B、C组静脉注射2 ml纳布啡。对比3组术中用药情况、术后恢复、疼痛情况、机械痛阈值、应激反应、免疫功能、血流动力学、不良反应与并发症。采用单因素方差分析、重复测量方差分析、LSD-t检验、χ²检验。结果　C组丙泊酚用量、瑞芬太尼用量、补救镇痛率、血管活性药物使用率均低于A组、B组，且B组均低于A组（均P<0.05）。3组术后住院时间、术后首次下地时间、术后首次进食时间、并发症与不良反应总发生率比较差异均无统计学意义（均P>0.05）。3组切口周围、前臂内侧机械痛阈值：术后6 h 、48 h均低于同组术前，术后48 h均高于同组术后6 h（均P<0.05）；C组术后6 h、48 h均高于A组、B组［（76.25±7.03）g比（41.31±5.22）g、（58.06±6.10）g，（81.19±8.24）g比（63.44±6.38）g、（76.30±7.21）g，（85.39±7.01）g比（72.06±5.23）g、（79.24±6.15）g，（95.07±8.36）g比（79.43±6.28）g、（87.31±7.12）g］，B组术后6 h、48 h均高于A组，差异均有统计学意义（均P<0.05）。3组VAS评分：术后48 h均低于同组术后1 h、6 h，术后6 h均低于同组术后1 h（均P<0.05）；C组术后1 h、6 h、48 h均低于A组、B组，且B组均低于A组（均P<0.05）。术后24 h，3组血清皮质醇、促肾上腺皮质激素、去甲肾上腺素水平均较同组术前升高，且C组均低于A组、B组，B组均低于A组（均P<0.05）。术后24 h，3组CD3+、CD4+水平均较同组术前降低，C组均高于A组、B组，B组均高于A组（均P<0.05）。3组心率、平均动脉压：麻醉结束时（T2）均比麻醉诱导后5 min（T1）低、比麻醉诱导前5 min（T0）高，且3组T1时刻均高于T0时刻（均P<0.05）；T1、T2时刻C组均低于A组、B组，B组均低于A组（均P<0.05）。结论　纳布啡联合RIB可抑制电视胸腔镜肺叶切除术患者的术后急性痛觉过敏，改善免疫功能，降低术中麻醉药物用量，减轻术后疼痛与应激反应，维持血流动力学稳定，且安全可靠。

关键词:

纳布啡, 菱形肌-肋间肌阻滞, 电视胸腔镜手术, 肺叶切除术, 急性痛觉过敏, 安全性