Effect of continuous serratus anterior plane block on postoperative recovery in elderly patients undergoing thoracoscopic radical resection of lung cancer
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摘要:
目的 探讨超声引导下连续前锯肌平面阻滞(SAPB)对老年胸腔镜肺癌根治术患者术后镇痛效果、术后恢复的影响。 方法 选择2019年10月—2020年6月蚌埠医学院第一附属医院拟行胸腔镜肺癌根治术的60名患者,采用简单随机法分为P组和SP组各30例。术后P组患者予以静脉自控镇痛, SP组行连续SAPB镇痛。比较2组术前和术后1、3、7 d休息和活动时VAS评分、术后恢复质量(QoR-40)评分、CD4+、CD4+/CD8+以及术后不良事件发生情况。 结果 SP组术后1、3 d静息及活动状态疼痛评分为(1.6±0.2)分、(2.3±0.4)分、(1.4±0.3)分、(1.9±0.3)分,低于P组的(2.5±0.3)分、(3.7±0.3)分、(2.1±0.2)分、(2.9±0.4)分(均P < 0.05)。SP组术后1、3 d QoR-40评分、CD4+、CD4+/CD8+分别为(170.7±3.2)分、(173.3±2.9)分、(40.8±6.4)%、(42.3±6.4)%、1.5±0.1、1.6±0.1,均高于P组的(162.8±3.7)分、(167.9±2.7)分、(36.2±6.2)%、(39.0±5.8)%、1.3±0.2、1.4±0.2(均P<0.05)。SP组术后不良反应发生率为4.6%,明显低于P组的17.3%(P<0.05)。 结论 超声引导下连续前锯肌平面阻滞作为术后镇痛策略,可以明显减轻老年胸腔镜肺癌根治术患者术后疼痛,减少应激反应和免疫抑制,促进患者早期康复。 Abstract:Objective To explore the effect of continuous serratus anterior plane block (SAPB) guided by ultrasound on postoperative analgesia and recovery in elderly patients undergoing thoracoscopic radical resection of lung cancer. Methods From October 2019 to June 2020, 60 patients in the First Affiliated Hospital of Bengbu Medical College undergoing thoracoscopic radical resection of lung cancer were selected and divided into the P group and SP group with 30 cases each by a simple random method. Patients in the P group received intravenous patient-controlled analgesia, whilst those in the SP group received continuous SAPB analgesia. The VAS scores of rest and activity, quality of postoperative recovery (QoR-40) scores, CD4+, CD4+/CD8+ and postoperative adverse events were compared between the two groups before and after 1, 3 and 7 days of surgery. Results The resting and active pain scores of the SP group were 1.6±0.2, 2.3±0.4, 1.4±0.3 and 1.9±0.3, which were lower than those of the P group (2.5±0.3, 3.7±0.3, 2.1±0.2, 2.9±0.4, all P < 0.05). The QOR-40 scores, CD4+ and CD4+/CD8+ in the SP group were 170.7±3.2, 173.3±2.9, 40.8±6.4, 42.3±6.4, 1.5±0.1, 1.6±0.1 at 1 and 3 days after surgery, which were higher than those in the P group (162.8±3.7, 167.9±2.7 and 36.2±6.2, 39.0±5.0, 1.3±0.2, 1.4±0.2, all P < 0.05). The postoperative adverse reaction rate in the SP group was 4.6%, which was significantly lower than that in the P group (17.3%, P < 0.05). Conclusion As a postoperative analgesic strategy, continuous SAPB guided by ultrasound can significantly reduce postoperative pain, reduce stress response and immunosuppression, and promote early recovery of elderly patients undergoing thoracoscopic radical resection of lung cancer. -
表 1 2组肺癌患者一般资料比较
组别 例数 年龄(x±s,岁) 身高(x±s,cm) 体重(x±s,kg) 手术时长(x±s,min) 性别(男/女,例) ASA分级(Ⅰ/Ⅱ,例) 手术侧(左/右,例) 胸引管(1/2条,例) P组 30 68.9±4.8 166.2±6.2 68.7±8.2 156.2±6.9 21/9 3/27 16/14 18/12 SP组 30 69.6±5.4 165.2±5.6 67.9±8.4 153.8±6.8 20/10 5/25 13/17 15/15 统计量 0.451a -0.590a -0.388a -1.330a 0.077b 0.144b 0.601b 0.606b P值 0.654 0.577 0.700 0.188 0.781 0.704 0.438 0.436 注:a为t值,b为χ2值。 表 2 2组肺癌患者不同时间点静息状态VAS评分(x±s, 分)
组别 例数 术后1 d 术后3 d 术后7 d F值 P值 P组 30 2.5±0.3 2.1±0.2a 1.5±0.2ab 69.419 < 0.001 SP组 30 1.6±0.2 1.4±0.3a 1.4±0.2a 227.045 < 0.001 t值 12.639 9.953 1.863 P值 < 0.001 < 0.001 0.068 注:与术后1 d比较, aP < 0.05;与术后3 d比较,bP < 0.05。 表 3 2组肺癌患者不同时间点活动状态VAS评分(x±s,分)
组别 例数 术后1 d 术后3 d 术后7 d F值 P值 P组 30 3.7±0.3 2.9±0.4a 2.1±0.2ab 208.434 < 0.001 SP组 30 2.3±0.4 1.9±0.3a 1.7±0.2ab 98.753 < 0.001 t值 12.574 12.517 6.856 P值 < 0.001 < 0.001 < 0.001 注:与术后1 d比较, aP < 0.05;与术后3 d比较,bP < 0.05。 表 4 2组肺癌患者不同时间点术后恢复质量评分(x±s,分)
组别 例数 术前 术后1 d 术后3 d 术后7 d F值 P值 P组 30 176.8±4.0 162.8±3.7a 167.9±2.7ab 174.8±3.6bc 72.060 < 0.001 SP组 30 177.6±3.4 170.7±3.2a 173.3±2.9ab 176.1±3.4bc 21.090 < 0.001 t值 0.821 8.834 7.332 1.488 P值 0.415 < 0.001 < 0.001 0.142 注:与术前比较,aP < 0.05;与术后1 d比较, bP < 0.05;与术后3 d比较,cP < 0.05。 表 5 2组肺癌患者不同时间点CD4+比较(x±s, %)
组别 例数 术前 术后1 d 术后3 d 术后7 d F值 P值 P组 30 45.0±6.4 36.2±6.2a 39.0±5.8ab 41.9±7.9abc 214.109 < 0.001 SP组 30 44.3±6.6 40.8±6.4a 42.3±6.4ab 44.1±6.5bc 11.398 < 0.001 t值 -0.438 2.798 2.059 1.170 P值 0.663 0.007 0.044 0.247 注:与术前比较,aP < 0.05;与术后1 d比较, bP < 0.05;与术后3 d比较,cP < 0.05。 表 6 2组肺癌患者不同时间点CD4+/CD8+比较(x±s)
组别 例数 术前 术后1 d 术后3 d 术后7 d F值 P值 P组 30 1.6±0.2 1.3±0.2a 1.4±0.2ab 1.5±0.2abc 241.222 < 0.001 SP组 30 1.6±0.1 1.5±0.1a 1.6±0.1ab 1.6±0.1bc 28.481 < 0.001 t值 -0.949 4.348 3.075 1.698 P值 0.347 < 0.001 0.003 0.096 注:与术前比较,aP < 0.05;与术后1 d比较, bP < 0.05;与术后3 d比较,cP < 0.05。 表 7 2组肺癌患者术后不良反应发生情况比较(例)
组别 例数 恶心 呕吐 肺不张 肺炎 低氧血症 P组 30 10 6 7 2 6 SP组 30 3 1 1 1 1 χ2值 4.812 4.043 0.351 0.351 4.043 P值 0.028 0.044 0.554 0.554 0.044 -
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