术前竖脊肌平面阻滞对胸部手术患者术后应激和阿片类药物需求的影响

汪晓燕; 潘琴; 黄常君; 李玉红

doi:10.16766/j.cnki.issn.1674-4152.003634

术前竖脊肌平面阻滞对胸部手术患者术后应激和阿片类药物需求的影响

doi: 10.16766/j.cnki.issn.1674-4152.003634

1.
杭州市临平区第一人民医院麻醉科，浙江杭州 311100
2.
树人学院树兰国际医学院，树兰(杭州)医院麻醉科，浙江杭州 310004

基金项目:

浙江省医药卫生科技计划项目 2024KY270

详细信息

通讯作者:
李玉红，E-mail：yuh_li@zju.edu.cn

中图分类号: R614.4;R734.2
计量
- 文章访问数: 1
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-11
- 网络出版日期: 2024-11-19

Effect of preoperative erector spinae plane block on postoperative stress and opioid demand of patients undergoing thoracic surgery

1.
Department of Anesthesiology, the First People ' s Hospital of Linping District, Hangzhou, Zhejiang 311100, China

摘要

摘要: 目的高剂量的阿片类镇痛药物可以控制胸部术后的剧烈疼痛，但容易引起恶心、呼吸抑制等副作用，本研究通过将术前竖脊肌平面阻滞(ESPB)应用于胸部手术，以探究其对患者术后应激和阿片类药物需求的影响。方法纳入2021年3月—2023年3月杭州市临平区第一人民医院收治的200例行肺癌根治术的患者，根据麻醉方式分为复合组(ESPB复合静脉全麻)和对照组(单纯全凭静脉麻醉)，各100例。比较2组患者氧化应激指标、血清相关指标、疼痛情况和阿片类药物使用情况。结果 2组肺癌患者术后24 h的丙二醛(MDA)水平均上升、超氧化物歧化酶(SOD)水平均下降，并且复合组MDA、SOD水平[(6.69±1.84)nmol/L、(37.30±6.42)U/mL]低于对照组[(9.03±1.35)nmol/L、(41.56±6.88)U/mL，P < 0.05]。T1、T2及T3时，复合组白细胞介素6(IL-6)、皮质醇(Cor)及血管紧张素Ⅱ(Ang-Ⅱ)水平均低于对照组，IL-10水平高于对照组(P < 0.05)。T2、T3和T4时，复合组静息、动态时VAS评分均低于对照组(P < 0.05)。复合组术中瑞芬太尼用量[(554.8±97.2)μg]、24 h内镇痛泵舒芬太尼输注总量[(28.7±5.9)mL]及追加次数[(2.1±0.6)次]均低于对照组[(675.2±164.5)μg、(39.5±6.2)mL、(3.2±0.9)次, P < 0.05]。结论 ESPB复合静脉全麻应用于肺癌根治术，可改善应激与炎症反应，减轻患者术后疼痛程度，降低对阿片类药物的需求，是一种具有可行性、优越性的麻醉方式。
- 竖脊肌平面阻滞 /
- 舒芬太尼 /
- 肺癌根治术 /
- 白细胞介素6
Abstract: Objective High-dose opioid analgesics can control severe pain after thoracic surgery, but can easily cause nausea, respiratory depression, and other side effects. In this study, erector spinae plane block (ESPB) was applied to thoracic surgery before operation to explore its influence on postoperative stress and opioid demand of patients. Methods From March 2021 to March 2023, 200 patients with lung cancer who underwent elective radical resection of lung cancer in the First People ' s Hospital of Linping District, Hangzhou were divided into a control group (pure intravenous anesthesia) and a compound group (ESPB combined intravenous general anesthesia) according to anesthesia methods, with 100 patients in each group. The indexes of oxidative stress, serum-related indexes, pain, and opioid use were compared between the two groups. Results Malondialdehyde (MDA) levels increased and super oxide dismutase (SOD) levels decreased 24 h after operation in lung cancer patients in both groups. Moreover, MDA and SOD levels in the compound group [(6.69±1.84) nmol/L, (37.30±6.42) U/mL] were lower than those in the control group [(9.03±1.35) nmol/L, (41.56±6.88) U/mL, P < 0.05]. At T1, T2, and T3, the levels of IL-6, Cor, and Ang-Ⅱ in the compound group were lower than those in the control group, and the levels of IL-10 were higher than those in the control group (P < 0.05). At T2, T3, and T4, the scores of resting and dynamic VAS in the compound group were lower than those in the control group (P < 0.05). The dosage of remifentanil in the compound group was (554.8±97.2) μg. The total amount of sufentanil infusion [(28.7±5.9) mL] and the number of supplementary infusion [(2.1±0.6) times] in 24 h were lower than those in the control group [(675.2±164.5) μg, (39.5±6.2) mL, (3.2±0.9) times, P < 0.05]. Conclusion The application of ESPB combined with intravenous general anesthesia in radical resection of lung cancer can improve stress and inflammatory reaction, and reduce postoperative pain and the demand for opioids. It is a feasible and superior anesthesia method.
- Erector spinae plane block /
- Sufentanil /
- Radical operation of lung cancer /
- Interleukin 6

HTML全文

表 1 2组肺癌患者一般资料比较

Table 1. Comparison of general data between the two groups of lung cancer patients

项目	对照组 (n=100)	复合组 (n=100)	统计量	P值
性别[例(%)]			0.362^a	0.547
男性	69(69.00)	65(65.00)
女性	31(31.00)	35(35.00)
年龄(x±s，岁)	58.36±9.20	56.74±9.35	1.235^b	0.218
BMI(x±s)	22.74±3.10	23.02±2.95	0.654^b	0.514
ASA分级[例(%)]			0.791^a	0.374
Ⅰ级	38(38.00)	32(32.00)
Ⅱ级	62(62.00)	68(68.00)
手术时间(x±s，min)	143.25±32.14	153.08±47.23	1.721^b	0.087
手术方式[例(%)]			0.878^a	0.645
全肺切除	24(24.00)	21(21.00)
肺叶切除	48(48.00)	45(45.00)
楔形切除	28(28.00)	34(34.00)
术中出血量(x±s，mL)	169.35±69.21	164.38±62.08	0.535^b	0.594
单肺通气时间(x±s，min)	121.65±8.67	124.09±9.85	1.859^b	0.064
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组肺癌患者不同时间点氧化应激项目比较(x±s)

Table 2. Comparison of oxidative stress items between two groups of lung cancer patients at different time points (x±s)

组别	例数	SOD(U/mL)		MDA(nmol/L)
组别	例数	术前	术后24 h	术前	术后24 h
对照组	100	46.20±7.48	41.56±6.88^b	5.78±1.38	9.03±1.35^b
复合组	100	45.35±7.42	37.30±6.42^b	5.85±1.34	6.69±1.84^b
统计量		0.807^a	40.950^c	0.364^a	116.217^c
P值		0.421	< 0.001	0.716	< 0.001
注：^a为t值，^c为F值；与同组术前比较，^bP < 0.05。

下载: 导出CSV

表 3 2组肺癌患者不同时间点血清相关指标比较(x±s)

Table 3. Comparison of serum-related indexes between the two groups of lung cancer patients at different time points (x±s)

组别	例数		IL-6(ng/L)			IL-10(ng/L)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
对照组	100	14.7±6.9	76.2±16.7^a	71.5±9.2^ab	72.3±10.5^a	34.5±11.8	45.3±10.9^a	74.3±16.5^ab	74.1±16.7^ab
复合组	100	14.1±6.2	53.5±14.6^a	59.4±3.8^ab	55.3±9.2^ac	35.2±8.8	54.7±9.7^a	84.3±9.5^ab	90.6±11.2^abc
F值		0.647	10.233	12.156	12.177	0.476	6.442	5.252	8.206
P值		0.519	< 0.001	< 0.001	< 0.001	0.635	< 0.001	< 0.001	< 0.001

组别	例数	Cor(μg/L)				Ang-Ⅱ(ng/L)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
对照组	100	91.3±18.2	120.6±15.6^a	138.2±10.5^ab	147.6±11.2^abc	33.4±6.2	48.5±7.1^a	54.3±7.9^ab	60.8±6.4^abc
复合组	100	95.7±19.2	109.5±18.4^a	121.3±14.8^ab	125.8±16.7^abc	33.9±6.7	42.6±6.3^a	43.1±7.2^a	47.8±7.1^abc
F值		1.663	4.601	9.313	10.841	0.548	6.216	10.478	13.600
P值		0.098	< 0.001	< 0.001	< 0.001	0.584	< 0.001	< 0.001	< 0.001
注：与同组T0比较，^aP < 0.05；与同组T1比较，^bP < 0.05；与同组T2比较，^cP < 0.05。

下载: 导出CSV

表 4 2组肺癌患者不同时间点静息、动态时疼痛评分比较(x±s，分)

Table 4. Comparison of resting and dynamic pain scores between the two groups of lung cancer patients at different time points (x±s, points)

组别	例数	静息时VAS评分			动态时VAS评分
组别	例数	T2	T3	T4	T2	T3	T4
对照组	100	2.6±0.8	3.1±0.9^a	3.5±1.1^ab	3.8±1.2	5.0±1.6^a	4.1±1.3^b
复合组	100	1.8±0.5	2.3±0.7^a	2.0±0.6^ab	2.7±0.8	3.4±1.1^a	2.2±0.7^ab
F值		8.480	7.016	11.971	7.627	8.240	12.868
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与同组T2比较，^aP < 0.05；与同组T3比较，^bP < 0.05。

下载: 导出CSV

表 5 2组肺癌患者阿片类药物需求比较(x±s)

Table 5. Comparison of opioid demand between the two groups of lung cancer patients (x±s)

组别	例数	术中瑞芬太尼用量(μg)	24 h内镇痛泵舒芬太尼
组别	例数	术中瑞芬太尼用量(μg)	输注总量(mL)	追加次数(次)
对照组	100	675.2±164.5	39.5±6.2	3.2±0.9
复合组	100	554.8±97.2	28.7±5.9	2.1±0.6
t值		6.301	12.619	10.170
P值		< 0.001	< 0.001	< 0.001

下载: 导出CSV

参考文献(15)

[1]	肖凡, 罗振中, 周斌, 等. 右美托咪定复合胸椎旁神经阻滞对开胸术后疼痛及认知功能的影响[J]. 南昌大学学报(医学版), 2018, 58(1): 60-64. XIAO F, LUO Z Z, ZHOU B, et al. Effect of dexmedetomidine combined with thoracic paravertebral block on pain and cognitive function after thoracotomy[J]. Journal of Nanchang University: Medical Sciences, 2018, 58(1): 60-64.
[2]	贡会源, 杏福宝, 李晨, 等. 单孔胸腔镜下Ⅰ期非小细胞肺癌根治术中模块化系统性淋巴结清扫的应用研究[J]. 中华全科医学, 2023, 21(9): 1482-1486. doi: 10.16766/j.cnki.issn.1674-4152.003151 GONG H Y, XING F B, LI C, et al. Application of modular systematic lymph node dissection in uniportal thoracoscopic radical resection for stage Ⅰ non-small cell lung cance[J]. Chinese Journal of General Practice, 2023, 21(9): 1482-1486. doi: 10.16766/j.cnki.issn.1674-4152.003151
[3]	JAYA A, TANTRI A R, HERIWARDITO A, et al. Single-centre, double-blind, randomised, parallel-group, superiority study to evaluate the effectiveness of general anaesthesia and ultrasound-guided transversus thoracis muscle plane block combination in adult cardiac surgery for reducing the surgical stress response: clinical trial protocol[J]. BMJ Open, 2021, 11(11): e051008. DOI: 10.1136/bmjopen-2021-051008.
[4]	LUIS-NAVARRO J C, SEDA-GUZMÁN M, LUIS-MORENO C, et al. The erector spinae plane block in 4 cases of video-assisted thoracic surgery[J]. Rev Esp Anestesiol Reanim (Engl Ed), 2018, 65(4): 204-208. doi: 10.1016/j.redar.2017.12.004
[5]	李群, 叶茂亭, 冉紫蕴, 等. 胸腔镜下肺癌根治术患者术后心脏并发症的影响因素分析[J]. 中国医学前沿杂志(电子版), 2021, 13(6): 53-57. LI Q, YE M T, RAN Z Y, et al. Analysis of the influencing factors of postoperative cardiac complications in lung cancer patients underwent thoracoscopic radical resection[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2021, 13(6): 53-57.
[6]	国家卫生健康委办公厅. 原发性肺癌诊疗指南(2022年版)[J]. 协和医学杂志, 2022, 13(4): 549-570. General Office of National Health Commission of the People ' s Republic of China. Clinical practice guideline for primary lung cancer (2022 version)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 549-570.
[7]	SHAFSHAK T S, ELNEMR R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain[J]. J Clin Rheumatol, 2021, 27(7): 282-285. doi: 10.1097/RHU.0000000000001320
[8]	王宁, 方园林, 路立军. 调整引流管进管方向与长度对改善胸腔闭式引流患者疼痛的临床研究[J]. 现代医药卫生, 2021, 37(13): 2272-2274. doi: 10.3969/j.issn.1009-5519.2021.13.031 WANG N, FANG Y L, LU L J. Clinical study on the improvement of pain in patients with closed thoracic drainage by adjusting the direction and length of drainage tube[J]. Journal of Modern Medicine & Health, 2021, 37(13): 2272-2274. doi: 10.3969/j.issn.1009-5519.2021.13.031
[9]	BOS E M E, HAUMANN J, DE QUELERIJ M, et al. Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases[J]. Br J Anaesth, 2018, 120(4): 693-704. doi: 10.1016/j.bja.2017.11.105
[10]	HERNANDEZ M A, PALAZZI L, LAPALMA J, et al. Erector spinae plane block for inguinal hernia repair in preterm infants[J]. Paediatr Anaesth, 2018, 28(3): 298-299. doi: 10.1111/pan.13325
[11]	TANTRI A R, RAHMI R, MARSABAN A, et al. Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block(ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial[J]. BMC Anesthesiol, 2023, 23(1): 13. doi: 10.1186/s12871-023-01973-w
[12]	HSING C H, WANG J J. Clinical implication of perioperative inflammatory cytokine alteration[J]. Acta Anaesthesiol Taiwan, 2015, 53(1): 23-28. doi: 10.1016/j.aat.2015.03.002
[13]	VEIGA M, COSTA D, BRAZÀO I. Erector spinae plane block for radical mastectomy: a new indication?[J]. Rev Esp Anestesiol Reanim (Engl Ed), 2018, 65(2): 112-115. doi: 10.1016/j.redar.2017.08.004
[14]	YAMAK ALTINPULLUK E, GARCÍA SIMÝN D, FAJARDO-PÉREZ M. Erector spinae plane block for analgesia after lower segment caesarean section: case report[J]. Rev Esp Anestesiol Reanim (Engl Ed), 2018, 65(5): 284-286. doi: 10.1016/j.redar.2017.11.006
[15]	RAFT J, RICHEBÉ P. Anesthesia for thoracic ambulatory surgery[J]. Curr Opin Anaesthesiol, 2019, 32(6): 735-742. doi: 10.1097/ACO.0000000000000795