罗哌卡因肋间神经阻滞对单孔胸腔镜术后患者SP、PGI2、NPY水平及VAS评分、Prince-Henry评分的影响-现代医学

罗哌卡因肋间神经阻滞对单孔胸腔镜术后患者SP、PGI2、NPY水平及VAS评分、Prince-Henry评分的影响

单位：南方医科大学附属小榄医院心胸外科, 广东中山 528415

分类号：R616.5;R614.4

出版年·卷·期（页码）：2018·46·第六期（616-620）

摘要：

目的：了解罗哌卡因肋间神经阻滞对单孔胸腔镜术后患者P物质（SP）、前列环素（PGI2）和神经肽Y（NPY）水平及视觉模拟评分（VAS）、术后疼痛评分（Prince-Henry评分）的影响。方法：选择采用单孔胸腔镜手术患者112例，按照随机分配的原则分为观察组和对照组，每组56例。观察组应用0.375%的罗哌卡因行肋间神经阻滞，对照组应用0.9%的生理盐水进行肋间神经阻滞。比较两组患者术后VAS评分、Prince-Henry评分、疼痛介质水平、疼痛缓解时间、静脉自控镇痛（PCIA）泵使用量和术后不良反应（肺不张、肺部感染、恶心、呕吐、呼吸抑制）发生情况。结果：肋间神经阻滞后，观察组患者手术后6 h（T1）、12 h（T2）和24 h（T3）的VAS评分、Prince-Henry评分均低于对照组，差异有统计学意义（t=49.898，P=0.000；t=13.265，P=0.000；t=28.390，P=0.000；t=48.945，P=0.000；t=37.407，P=0.000；t=4.653，P=0.000）。观察组患者PGI2和SP水平低于对照组，NPY水平高于对照组，差异有统计学意义（t=16.134，P=0.000；t=14.204，P=0.000；t=19.684，P=0.000）。观察组患者T1、T2和T3的PCIA泵使用量均低于对照组，差异有统计学意义（t=13.850，P=0.000；t=6.196，P=0.000；t=34.526，P=0.000）；观察组患者疼痛缓解时间较对照组更短，差异有统计学意义（t=12.991，P=0.000）。对照组术后出现肺不张4例，肺部感染6例，恶心、呕吐2例，呼吸抑制1例，不良反应发生率为23.21%；观察组术后出现肺不张1例，肺部感染1例，恶心、呕吐0例，呼吸抑制0例，不良反应发生率为3.57%；观察组不良反应发生率明显低于对照组，差异有统计学意义（χ²=9.619，P=0.022）。结论：对单孔胸腔镜手术患者应用0.375%的罗哌卡因进行肋间神经阻滞，可以较好地降低术后各时间点的疼痛程度，平衡疼痛介质水平，降低不良反应发生率。

Objective:To investigate the effect of ropivacaine intercostal nerve block on substance P(SP), prostaglandin I2(PGI2), neuropeptide Y(NPY), Visual Analogue scale(VAS) score and Prince-Henry score in patients after single hole thoracoscopic surgery. Methods:112 patients undergoing thoracoscopic surgery were divided into observation group and control group according to the principle of random allocation, 56 cases in each group. The observation group was treated with 0.375% ropivacaine for intercostal nerve block, and the control group used 0.9% saline to block intercostal nerve. The postoperative VAS score, Prince-Henry score, level of pain medium, pain relief time, patient controlled intravenous analgesia(PCIA) pump volume and postoperative adverse reactions (atelectasis, lung infection, nausea, vomiting and respiratory depression) were compared between the two groups. Results:After intercostal nerve block, the VAS score and Prince-Henry score of the patients in observation group at 6 h (T1), 12 h (T2) and 24 h (T3) after surgery were lower than those in the control group, the difference was statistically significant(t=49.898,P=0.000;t=13.265,P=0.000;t=28.390,P=0.000;t=48.945,P=0.000;t=37.407,P=0.000;t=4.653,P=0.000);The levels of PGI2 and SP in the observation group were lower than those of the control group, and the level of NPY was higher than that of the control group, the difference was significant(t=16.134,P=0.000;t=14.204,P=0.000;t=19.684,P=0.000). The PCIA pump usage of the patients in observation group at T1, T2 and T3 after surgery were lower than those in the control group, the difference was statistically significant(t=13.850,P=0.000;t=6.196,P=0.000;t=34.526,P=0.000). The pain relief time of the observation group was shorter than that of the control group, and the difference was significant(t=12.991,P=0.000). There were 4 cases of atelectasis, 6 cases of pulmonary infection, 2 cases of nausea and vomiting, 1 case of respiratory depression in the control group, and the incidence of adverse reactions was 23.21%. There were 1 case of atelectasis, 1 case of pulmonary infection, 0 case of nausea and vomiting, 0 case of respiratory depression in the observation group, and the incidence of adverse reactions was 3.57%. The incidence of adverse reactions in the observation group was significantly lower than that in the control group (χ²=9.619,P=0.022). Conclusion:Intercostal nerve block with 0.375% ropivacaine can reduce the pain level at each time point, balance the level of pain media and reduce the incidence of adverse reactions in patients undergoing single hole thoracoscopic surgery.

参考文献：

[1] 黎志伟,赖有平,邢首平,等.不同剂量右美托咪定复合罗哌卡因对胸科手术患者的镇痛作用及对其P物质和IL-6水平的影响[J].实用医药杂志,2017,34(5):411-413,416.
[2] 陈顺富,陈雷,叶钢,等.羟考酮联合肋间神经阻滞用于胸腔镜下肺叶切除术后镇痛[J].中国现代医学杂志,2017,27(5):100-103.
[3] 杜丽,唐育民.曲马多联合罗哌卡因行肋间神经阻滞用于肺癌患者术后镇痛的临床研究[J].东南大学学报:医学版,2015,34(2):235-239.
[4] 杨峻岭,潘治滨.帕瑞昔布钠复合肋间神经不同时点阻滞对胸腔镜手术后早期疼痛的影响[J].吉林医学,2016,37(5):1082-1083.
[5] 黄丹,周斌,肖凡,等.右美托咪定行胸椎旁神经阻滞对开胸手术患者应激反应的影响[J].中国现代医学杂志,2017,27(14):87-92.
[6] 杨泽山.431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781,1868.
[7] ZAOUTER C,KANEVA P,CARLI F.Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia[J].Reg Anesth Pain Med,2009,34(6):542-548.
[8] PÖPPING D M,ELIA N,MARRET E,et al.Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery:a meta-analysis[J].Arch Surg,2008,143(10):990-999.
[9] GUAY J.The benefits of adding epidural analgesia to general anesthesia:a metaanalysis[J].J Anesth,2006,20(4):334-340.
[10] DOI H,IZUMI K,KAWASAKI S,et al.Superior mesenteric artery syndrome following scoliosis surgery during intravenous patient controlled analgesia (IV-PCA) with fentanyl:a case report[J].Masui,2016,65(1):93-96.
[11] RODGERS A,WALKER N,SCHUG S,et al.Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia:results from overview of randomised trials[J].BMJ,2000,321(7275):1493.
[12] LUKETICH J D,LAND S R,SULLIVAN E A,et al.Thoracic epidural versus intercostal nerve catheter plus patient-controlled analgesia:a randomized study[J].Ann Thorac Surg,2005,79(6):1845-1850.
[13] FIBLA J J,MOLINS L,MIER J M,et al.The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery:a randomized trial[J].Eur J Cardiothorac Surg,2011,40(4):907-911.
[14] 李跃,宫立群,徐锋,等.罗哌卡因肋间神经阻滞对肺癌患者胸腔镜术后镇痛效果的影响[J].中国肿瘤临床,2017,44(12):605-607.
[15] ISHIKAWA Y,MAEHARA T,NISHⅡ T,et al.Intrapleural analgesia using ropivacaine for postoperative pain relief after minimally invasive thoracoscopic surgery[J].Ann Thorac Cardiovasc Surg,2012,18(5):429-433.
[16] 蔡岷.腹腔镜胆囊切除术患者围术期微循环及疼痛相关指标的变化[J].海南医学院学报,2015,21(7):944-946.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录