临床误诊误治2025，Vol.38Issue(9)：45-52,8.DOI:10.3969/j.issn.1002-3429.2025.09.008
术前超声下椎旁神经阻滞联合术毕前锯肌平面阻滞在肺癌患者电视辅助胸腔镜手术中的应用价值
Application Value of Preoperative Ultrasound-guided Paravertebral Nerve Block Combined with End-of-Operation Serratus Anterior Plane Block in Video-assisted Thoracoscopic Surgery for Patients with Lung Cancer
摘要
Abstract
Objective To evaluate the application effect of preoperative ultrasound-guided paravertebral nerve block(PVB)combined with end-of-operation serratus anterior plane block(SAPB)in video-assisted thoracoscopic surgery(VATS)for patients with lung cancer.Methods A total of 126 patients with lung cancer who received VATS from January 2022 to June 2024 were selected and divided into control group(n=63)and observation group(n=63)by random number table method.The control group was given preoperative ultrasound-guided PVB,and the observation group was given preoperative ultrasound-guided PVB combined with end-of-operation SAPB.The two groups were compared at the time of entry(T0),at 30 min after extubation(T1),at 12 h after surgery(T2),24 h after surgery(T3)and 48 h after surgery(T4)with respect to hemodynamic changes[heart rate,mean arterial pressure(MAP)],pain mediators[prostaglandin E2(PGE2),Substance P(SP),β-endorphin(β-EP)],levels of inflammatory factors[high mobility group protein B1(HMGB1),C reactive protein(CRP),interleukin-6(IL-6)],resting and active visual analogue scale(VAS)pain scores at T1,T2,T3,and T4,rehabil-itation related indicators,adverse reactions.Results The fluctuation of heart rate and MAP at T0-T4 in the observation group was smaller than that in the control group(P＜0.05).The resting and active VAS pain scores at 2 h,4 h and 8 h in the ob-servation group were lower than those in the control group(P＜0.01).PGE2,SP,β-EP,HMGB1,CRP and IL-6 in obser-vation group were lower than those in control group at T2 and T4(P＜0.01).The time of food intake,the first time of anal exhaust,the first time of off-bed activity,and the duration of hospitalization in the observation group were shorter than those in the control group(P＜0.01).The first time of PCIA compression in the observation group was later than that in the control group,and the effective times of PCIA compression and Sufentanil consumption at 48 h after surgery were lower than those in the control group(P＜0.01).There was no significant difference in the incidence of adverse reactions between the observa-tion group[7.94%(5/63)]and the control group[4.76%(3/63)](P＞0.05).Conclusion The application of preop-erative ultrasound-guided PVB combined with end-of-operation SAPB in VATS for lung cancer is significant,which can stabi-lize the hemodynamics of patients,effectively reduce postoperative pain,inhibit the release of pain mediators and inflammatory factors,and promote rapid postoperative recovery of patients,with certain safety.关键词
肺肿瘤/电视辅助胸腔镜手术/麻醉/椎旁神经阻滞/前锯肌平面阻滞/术后镇痛/血流动力学/高迁移率族蛋白B1Key words
Lung neoplasms/Video-assisted thoracoscopic surgery/Anesthesia/Paravertebral nerve block/Serratus anterior plane block/Postoperative analgesia/Hemodynamics/High mobility group protein B1分类
临床医学引用本文复制引用
孙婧婧,路敏,杨静..术前超声下椎旁神经阻滞联合术毕前锯肌平面阻滞在肺癌患者电视辅助胸腔镜手术中的应用价值[J].临床误诊误治,2025,38(9):45-52,8.基金项目
河北省2023年度医学科学研究课题(20232148) （20232148）
沧州市科学技术局项目(213106066) （213106066）
