竖脊肌不同阻滞时机在胸腔镜肺叶切除术后镇痛作用及对肺功能、血清疼痛因子、NE、PGE2的影响

doi:10.3969/j.issn.1007-3205.2023.01.021

河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 106-111.doi: 10.3969/j.issn.1007-3205.2023.01.021

竖脊肌不同阻滞时机在胸腔镜肺叶切除术后镇痛作用及对肺功能、血清疼痛因子、NE、PGE2的影响

南通大学附属南通第三医院麻醉科，江苏南通 226000

出版日期:2023-01-25 发布日期:2023-01-17
作者简介:佘勇军(1980-)，男，江苏南通人，南通大学附属南通第三医院副主任医师，医学硕士，从事心胸外科麻醉，肝功能保护研究。
基金资助:
南通市市级科技计划项目（MSZ18130）

Analgesic effect of erector spinae muscle block at different timings after thoracoscopic lobectomy and its impact on pulmonary function, serum pain factors, NE and PGE2

Department of Anesthesiology, the Third People′s Hospital of Nantong City, Nantong University， Jiangsu Province, Nantong 226006, China

Online:2023-01-25 Published:2023-01-17

摘要/Abstract

摘要： 目的探讨竖脊肌不同阻滞时机在胸腔镜肺叶切除术后镇痛作用及对肺功能、血清疼痛因子、去甲肾上腺素（norepinephrine，NE）、前列腺素E2（prostaglandin E2，PGE2）的影响。
方法应用前瞻性随机对照研究方法和1∶1试验设计原则将我院收治的88例胸腔镜肺叶切除术患者分为2组，各44例。2组术后均给予自控静脉镇痛，观察组在切皮前给予超声引导下单侧竖脊肌平面阻滞，对照组在术毕给予超声引导下单侧竖脊肌平面阻滞。比较两组静息与咳嗽疼痛视觉模拟评分法（visual analogue scale，VAS）评分、疼痛因子［5-羟色胺（5-hydroxytryptamine，5-HT）、血清P物质（substance P，SP）、神经肽Y（neuropeptide Y，NPY）］、血流动力学［心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）］、NE、PGE2、第1秒用力呼气容积占预计值百分比（forced expiratory volume in one second，FEV1%预计值）、FEV1/用力肺活量（forced vital capacity，FVC）、并发症。
结果 2组拔管后即刻、拔管后1 h、拔管后6 h、拔管后24 h、拔管后48 h静息VAS评分与咳嗽VAS评分比较，差异无统计学意义（P＞0.05）；两组拔管后即刻、拔管后6 h、拔管后24 h的5-HT、SP、NPY比较，差异无统计学意义（P＞0.05）；观察组插管后、切皮、拔管即刻HR、MAP低于对照组（P＜0.05）；观察组插管后、切皮、拔管即刻NE、PGE2低于对照组（P＜0.05）；观察组拔管后48 h FEV1%预计值、FEV1/FVC高于对照组（P＜0.05）；观察组并发症发生率（6.82%）与对照组（11.36%）比较，差异无统计学意义（P＞0.05）。
结论胸腔镜肺叶切除术患者切皮前与术毕竖脊肌阻滞均能有效控制疼痛，但前者在减轻应激反应、保持血流动力学稳定、改善术后早期肺功能方面更具优势，且安全可靠。

关键词: 胸腔镜, 竖脊肌, 镇痛

Abstract: Objective To investigate the analgesic effect of erector spinae muscle block at different timings after thoracoscopic lobectomy and its impact on pulmonary function, serum pain factors, norepinephrine (NE) and prostaglandin E2 (PGE2).
Methods In this prospective randomized controlled study, a total of 88 patients undergoing thoracoscopic lobectomy in our hospital were assigned in a 1∶1 ratio to two groups, with 44 cases in each group. Both groups were given patient-controlled intravenous analgesia after surgery. The observation group was given ultrasound-guided unilateral erector spinae plane block before skin incision, and the control group was given ultrasound-guided unilateral erector spinae plane block after surgery. The visual analogue scale (VAS) pain scores at rest and during cough, pain factors ［5-hydroxytryptamine (5-HT), serum substance P (SP), neuropeptide Y(NPY)］, hemodynamics ［heart rate (HR), mean arterial pressure (MAP)］, NE, PGE2, percentage of predicted forced expiratory volume in 1 second (FEV1% pred), FEV1/forced vital capacity (FVC), and complications were compared between two groups.
Results There was no significant difference between VAS scores at rest and during cough immediately after extubation, and at 1 h, 6 h, 24 h, and 48 h after extubation in the two groups (P＞0.05). The comparison of 5-HT, SP, NPY immediately after extubation, at 6 h and 24 h after extubation between the two groups was not statistically significant (P＞0.05).HR and MAP immediately after extubation, at skin incision, and at 24 h after intubation were lower in the observation group than in the control group (P＜0.05); NE and PGE2 immediately after intubation, at skin incision and immediately after extubation in were lower in the observation group than in the control group (P＜0.05).FEV1% pred and FEV1/FVC at 48 h after extubation were higher in the observation group than in the control group (P＜0.05); the complication rate of the observation group (6.82%) was not significantly different from that of the control group (11.36%) (P＞0.05).
Conclusion Thoracoscopic lobectomy before skin incision and erector spinae muscle block after operation can effectively control pain, and the former has advantages in reducing stress response, maintaining hemodynamic stability, and improving early postoperative lung function, with good safety and reliability.

Key words: thoracoscopes, erector spinae, analgesia

佘勇军, 邢春花, 屈文平. 竖脊肌不同阻滞时机在胸腔镜肺叶切除术后镇痛作用及对肺功能、血清疼痛因子、NE、PGE2的影响 [J]. 河北医科大学学报, 2023, 44(1): 106-111.

SHE Yong-jun, XING Chun-hua, QU Wen-ping. Analgesic effect of erector spinae muscle block at different timings after thoracoscopic lobectomy and its impact on pulmonary function, serum pain factors, NE and PGE2[J]. Journal of Hebei Medical University, 2023, 44(1): 106-111.

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竖脊肌不同阻滞时机在胸腔镜肺叶切除术后镇痛作用及对肺功能、血清疼痛因子、NE、PGE2的影响

Analgesic effect of erector spinae muscle block at different timings after thoracoscopic lobectomy and its impact on pulmonary function, serum pain factors, NE and PGE2

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