超声引导下胸椎旁神经阻滞联合丙泊酚全麻对肺癌手术及术后急慢性疼痛的临床观察

目的:观察超声引导下胸椎旁神经阻滞联合丙泊酚全麻对肺癌手术及术后急慢性疼痛发生的临床观察。方法:选取102例肺癌患者为受试对象，随机数字表法分为观察组与对照组，各51例。观察组实施胸椎旁神经阻滞联合丙泊酚静脉全麻，对照组给予七氟醚吸入复合静脉药物全麻。比较两组围手术期不同时间点的血流动力学指标如收缩压（SBP）、舒张压（DBP）、心率（HR），观察术中两组患者阿片药物使用量，观察两组术后安静、主动咳嗽状态下不同时间点的疼痛程度视觉模拟（VAS）评分和48 h内PCA泵总用量及按压次数，随访患者出院后慢性疼痛发生状况。结果:两组患者T0时SBP、DBP、HR比较均无统计学意义（P>0.05），而T1、T2时，两组患者SBP、DBP均较T0时显著下降（P<0.05），且对照组显著高于观察组（P<0.05），T1时两组患者HR较T0时无明显变化（P>0.05），T2时两组HR均较T0时显著下降（P<0.05），且对照组显著高于观察组（P<0.05），而对照组T2时HR较T1时显著降低（P<0.05）；术中对照组阿片药物使用量高于观察组（P<0.05）；术后48 h内，观察组镇痛泵按压次数显著少于对照组（P<0.05）；术毕拔管时，术后2 h、24 h，观察组患者安静、主动咳嗽状态下VAS评分均显著低于对照组（P<0.05），术后24 h，观察组安静、主动咳嗽状态下VAS评分均较术后2 h显著升高（P<0.05），而对照组安静状态下VAS评分较术后2 h显著升高（P<0.05），主动咳嗽状态下较术后2 h无统计学意义（P>0.05）。出院后随访期间，观察组慢性疼痛发生率低于对照组（P<0.05）。结论:超声引导下胸椎旁神经阻滞联合丙泊酚全麻可有效降低肺癌手术患者术后疼痛程度，不仅有利于手术过程中血流动力学指标，减少术中麻醉药物用量和降低术后疼痛发生率，更有利于肺癌患者的术后康复。

Ultrasound-guided thoracic paravertebral nerve block combined with propofol general anesthesia for lung cancer surgery and evaluation of acute and chronic post-surgical pain

objective To explore the effect of ultrasound-guided thoracic paravertebral nerve block combined with propofol general anesthesia on lung cancer surgery and to evaluate the acute and chronic post-surgical pain. Methods A total of 102 patients with lung cancer were enrolled and randomly divided into observation group and control group, with 51 cases in each group. Control group was given sevoflurane inhalation combined with intravenous medication for general anesthesia, while observation group was treated with thoracic parathoracic nerve block-propofol intravenous general anesthesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at different perioperative time points, the dosage of opioid drug used during surgery, the post-surgical visual analogue score (VAS) at different time points in a calm state and active coughing state, and the total dosage and pressing frequency of PCA within 48 h were compared between two groups. All patients were followed-up for assessing the chronic pain after discharge Results There was no statistically significant difference in SBP, DBP and HR at T0 between two groups (P>0.05). The SBP and DBP in two groups at T1 and T2 were significantly decreased as compared with those at T0 (P<0.05), and the indexes in control group were significantly higher than those in observation group (P<0.05). The HR in two groups at T1 was close to that at T0 (P>0.05), but the HR at T2 was significantly decreased compared with that at T0 (P<0.05), and the HR in control group was significantly higher than that in observation group (P<0.05), and the HR in control group at T2 was significantly decreased compared with that at T1 (P<0.05). More opioid drug was used in control group than in observation group (P<0.05). Within 48 h after surgery, the frequency of analgesic pump pressing in observation group was significantly less than that in control group (P<0.05). At extubation and 2 h and 24 h after surgery, the VAS in observation group in a clam state and active coughing state were significantly lower than those in control group (P<0.05). The VAS in observation group at 24 h after surgery in a clam state and active coughing state were significantly increased compared with those at 2 h after surgery (P<0.05), while in control group, the VAS in a clam state was significantly higher than that at 2 h after surgery (P<0.05), and the difference in the score at active coughing state between 24 h and 2 h after surgery was trivial (P>0.05). The follow-up showed that observation group had a lower incidence of chronic pain than control group (P<0.05). Conclusion Thoracic paravertebral nerve block-propofol general anesthesia can effectively reduce the pain after lung cancer surgery, and it is beneficial to the hemodynamics during surgery, the reduction of the dosage of anesthetic drug, the relief of postoperative pain, and the postoperative rehabilitation of patients with lung cancer.