摘要
目的 分析胸椎旁神经阻滞(TPVB)在肺癌手术患者中的应用及对机体应激、免疫功能的影响。方法选取2022年3月至2023年5月宜宾市第二人民医院收治的200例肺癌手术病例,随机分至研究组(接受TPVB)、对照组(采用肋间神经阻滞)各100例,记录2组恢复情况,对比其疼痛视觉模拟评分(VAS),分析2组术前(T0)、给药15 min(T1)、诱导插管后(T2)、切皮时刻(T3)、拔管前(T4)平均动脉压(MAP)、心率、皮质醇(Cor)浓度,比较2组免疫功能指标、蒙特利尔认知评估量表(MoCA)评分及不良反应发生率。结果研究组恢复自主呼吸、首次排气、首次下床活动的时间均较对照组缩短,研究组的丙泊酚用量更低(P<0.05),2组手术时间、麻醉时间差异无统计学意义(P>0.05);研究组术后VAS评分优于对照组(P<0.05);研究组T1~T4时的MAP、心率、Cor均低于对照组(P<0.05);术后48 h研究组CD8^(+)低于对照组,而CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05);研究组术后24 h、48 h的MoCA评分较对照组更高,而术后48 h认知功能障碍发生率更低(P<0.05);研究组不良反应发生率低于对照组(P<0.05)。结论TPVB应用在肺癌手术患者中,可促进其术后康复,镇痛效果满意,利于减少对机体应激、免疫功能的影响,且术后发生认知功能障碍及不良反应风险低。
Objective To analyze the application of thoracic paravertebral block(TPVB)in patients undergoing lung cancer surgery,and the influence on stress and immune function.Methods A total of 200 patients who underwent lung cancer surgery in the Second People′s Hospital of Yibin Hospital from March 2022 to May 2023 were selected as the research subjects.They were divided into the study group(TPVB)and the control group(intercostal nerve block)by random number table method,with 100 patients in each group.The recovery status of the two groups was recorded,and their pain visual analogue scale(VAS)scores were compared.Mean arterial pressure(MAP),heart rate(HR)and cortisol(Cor)concentrations in the two groups before surgery(T0),after 15 min of medication(T1),after induction and intubation(T2),at skin incision(T3)and before extubation(T4)were analyzed.Immune function indicators,montreal cognitive assessment(MoCA)scores,and the incidence of adverse reactions were compared between the two groups.Results The recovery time of spontaneous respiration,first exhaust time,first ambulatory time,and the dosage of propofol in the study group were shorter/lower than those in the control group(P<0.05).Surgical time and anesthesia duration of the two groups had no significant difference(P>0.05).The VAS scores of the study group at 12 h,24 h,and 48 h after surgery were lower than those of the control group(P<0.05).MAP,HR,and Cor of the study group from T1 to T4 were lower than those of the control group(P<0.05).The level of CD8^(+)in the study group at 48 h after surgery was lower than those in the control group.CD4^(+)and CD4^(+)/CD8^(+)were higher than those in the control group(P<0.05).The MoCA scores of the study group at 24 h and 48 h after surgery were higher than those of the control group,and the incidence of cognitive impairment at 48 h after surgery was lower than that in the control group(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group(P<0.05).Conclusion The application of TP
作者
唐建姚
洪林
任静华
Tang Jian;Yao Honglin;Ren Jinghua(Department of Anesthesiology,Second People′s Hospital of Yibin Hospital,Sichuan 644000,China)
出处
《山西医药杂志》
CAS
2024年第3期174-179,共6页
Shanxi Medical Journal
关键词
胸椎旁神经阻滞
肺癌手术
机体应激
免疫功能
认知功能障碍
Thoracic paravertebral block
Lung cancer surgery
Systemic stress
Immune function
Cognitive impairment
