摘要
目的评价不同时机胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后远期生活质量的影响。方法择期行胸腔镜肺癌根治术患者150例,年龄25~64岁,BMI 18~24 kg/m2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法将其分为3组(n=50):术前胸椎旁神经阻滞组(P1组)、术毕胸椎旁神经阻滞组(P2组)和术前联合术毕胸椎旁神经阻滞组(P3组)。P1组麻醉诱导前行超声引导下患侧T4,6两点椎旁神经阻滞,注入0.5%罗哌卡因共10 ml;P2组术毕行超声引导下患侧T4,6两点椎旁神经阻滞,注入0.5%罗哌卡因共10 ml;P3组麻醉诱导前和术毕分别行超声引导下患侧T4,6两点椎旁神经阻滞,每次注入0.5%罗哌卡因共10 ml;3组术毕时连接镇痛泵。术后随访,VAS评分≥4分时,从镇痛泵内抽取5 ml静脉注射。记录3组患者术后6和12月电话随访术后慢性疼痛的发生情况,并评价疼痛对日常生活的影响和处理措施评分;采用简明健康相关生命质量量表评估患者生活质量,计算生理健康评分和心理健康评分。结果3组患者术后6和12月慢性疼痛发生率差异无统计学意义(P>0.05);与术后6月比较,3组患者术后12月生理健康评分和心理健康评分降低(P<0.05)。与P1组和P2组比较,P3组患者术后疼痛对日常生活影响评分和疼痛处理措施评分降低,术后12月生理健康评分和心理健康评分升高(P<0.05)。结论术前联合术毕胸椎旁神经阻滞可有效改善胸腔镜肺癌根治术患者术后远期生活质量。
Objective To evaluate the effect of thoracic paravertebral nerve block(TPVB)at different time points on postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer.Methods One hundred and fifty patients of both sexes,aged 25-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective radical resection of lung cancer,were divided into 3 groups(n=50 each)by a random number table method:preoperative TPVB group(P1 group),TPVB at the end of operation group(P2 group)and preoperative TPVB combined with TPVB at the end of operation group(P3 group).In group P1,TPVB was performed at T4,6 points on the affected side under ultrasound guidance before anesthesia induction,and 0.5%ropivacaine 10 ml was injected in total.In group P2,TPVB was performed at T4,6 points on the affected side under ultrasound guidance at the end of operation,and 0.5%ropivacaine 10 ml was injected in total.In group P3,TPVB was performed at T4,6 points on the affected side under ultrasound guidance before anesthesia induction and at the end of operation,and 0.5%ropivacaine 10 ml was injected each time.The analgesia pump was connected at the end of operation in three groups.The patients were followed up after operation,and 5 ml solution extracted from the analgesic pump was intravenously injected when VAS score was greater than or equal to 4.The occurrence of postoperative chronic pain in the 3 groups was recorded though telephone follow-up at 6 and 12 months after surgery,and the effect of pain on daily life and treatment measures were scored.A concise health-related quality of life scale was used to evaluate patients′quality of life,and the physical and mental health scores were calculated.Results There was no significant difference in the incidence of chronic pain at 6 and 12 months after surgery among the three groups(P>0.05).The physical and mental health scores were significantly decreased at 12 months after surgery than at
作者
刘瑶
李冰
孟星
张加强
张伟
Liu Yao;Li Bing;Meng Xing;Zhang Jiaqiang;Zhang Wei(Department of Anesthesiology,Zhengzhou People′s Hospital,Zhengzhou 450003,China;Department of Anesthesiology,People′s Hospital of Zhengzhou University(Henan Provincial People′s Hospital),Zhengzhou 450003,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第9期1047-1050,共4页
Chinese Journal of Anesthesiology
基金
河南省医学科技攻关项目(201602227)
河南省医学科技攻关计划联合共建项目(2018020844)。
关键词
神经传导阻滞
胸腔镜
肺肿瘤
生活质量
Nerve block
Thoracoscopes
Lung neoplasms
Quality of life
