刘忠涛

[摘要] 目的 探討胸椎旁神经阻滞联合全麻对肺癌切除术后患者血清心肌酶水平的影响。 方法 选择2017年2月至2019年12月在本院进行胸腔镜下肺癌切除术患者86例，分为观察组与对照组，每组各43例。对照组给予双腔支气管插管全身麻醉，观察组在对照组麻醉的基础上给予胸椎旁神经阻滞，记录麻醉效果与血清心肌酶水平变化情况。 结果 观察组使用量丙泊酚为（822.14±15.29）mg、舒芬太尼为（0.92±0.11）mg，与对照组丙泊酚（824.09±18.22）mg、舒芬太尼（0.98±0.08）mg比较，差异无统计学意义（P>0.05）。观察组疼痛VAS评分术后24 h为（1.89±0.38）分、36 h（1.65±0.22）分与72 h（1.34±0.17）分，均显著低于对照组24 h的（3.42±0.32）分、36 h（3.18±0.17）分与72 h（3.00±0.16）分（P<0.05）。观察组术后72 h的恶心、躁动、眩晕、胸闷等不良反应发生率（4.7%）显著低于对照组（27.9%）（P<0.05）。对照组术后72 h的血清LDH为（204.77±21.04）U/L与CK-MB（22.72±1.84）U/L均高于术前12 h与观察组（P<0.05），观察组术前血清LDH（198.38±12.47）U/L、CK-MB（12.49±1.48）U/L与术后LDH（168.29±17.76）U/L、CK-MB（13.01±1.74）U/L比较，差异无统计学意义（P>0.05）。 结论 胸椎旁神经阻滞联合全麻在肺癌切除术患者的应用不会增加全麻剂量，且能抑制血清心肌酶的释放，可减少术后不良反应的发生，提高术后镇痛效果。

[关键词] 胸椎旁神经阻滞;全麻;肺癌切除术;心肌酶;不良反应

[中图分类号] R735.1          [文献标识码] B          [文章编号] 1673-9701（2021）12-0123-03

Effect of thoracic paravertebral nerve block combined with general anesthesia on serum myocardial enzyme levels in patients after lung cancer resection

LIU Zhongtao

Department of Anesthesiology， the Central Hospital of Jiamusi City in Heilongjiang Province， Jiamusi   154002， China

[Abstract] Objective To explore the effect of thoracic paravertebral nerve block combined with general anesthesia on serum myocardial enzyme levels in patients after lung cancer resection. Methods A total of 86 patients who underwent thoracoscopic lung cancer resection in our hospital from February 2017 to December 2019 were selected as the research objects. According to the random number table method， they were divided into the observation group and the control group， with 43 cases in each group. The control group was given general anesthesia with dual-chamber bronchial intubation， and the observation group was given thoracic paravertebral nerve block based on the control group′s anesthesia. The effects of anesthesia and changes in serum myocardial enzyme levels were recorded. Results There was no significant difference in propofol [（822.14±15.29） mg vs. （824.09±18.22）mg] and sufentanil[（0.92±0.11） mg vs.（0.98±0.08）mg] between the observation group and the control group（P>0.05）.The pain VAS scores of the observation group at 24 h（1.89±0.38）points， 36 h （1.65±0.22） pointsv，and 72 h（1.34±0.17） points were significantly lower than those of the control group at 24 h（3.42±0.32） points，36 h（3.18±0.17） points，and 72 h（ 3.00±0.16） points（P<0.05）. The incidence of adverse reactions such as nausea， restlessness， dizziness， and chest tightness in the observation group 72 hours after surgery was 4.7%， significantly lower than that （27.9%） of the control group （P<0.05）. Serum LDH （204.77±21.04）U/L and CK-MB （22.72±1.84） U/L of the control group 72 h after surgery were higher than those at 12 h before surgery and those of the observation group （P<0.05）. There was no significant difference in the serum LDH [（198.38±12.47）U/L vs. （168.29±17.76）U/L]and CK-MB [（12.49±1.48） U/L vs. （13.01±1.74）U/L] before and after surgery in the observation group（P>0.05）. Conclusion The application of thoracic paravertebral nerve block combined with general anesthesia in patients undergoing lung cancer resection can inhibit the release of serum myocardial enzymes， improve postoperative analgesia， reduce postoperative adverse reactions， and not increase the dose of general anesthesia.

[Key words] Thoracic paravertebral nerve block; General anesthesia; Lung cancer resection; Myocardial enzymes; Adverse reactions

肺癌为临床多发恶性肿瘤疾病，其中非小细胞肺癌占80%以上。外科手术为肺癌的主要治疗方法，其中胸腔镜下肺癌切除术具有创伤小、安全性高等多种特征，但是具有手术操作复杂、手术时间长等缺点，特别是手术刺激和麻醉操作可导致患者在围手术期出现强烈的应激反应。全麻为肺癌切除术的主要麻醉方法，但是全麻可引发许多不良反应的发生及围术期应激反应等，并影响患者的预后康复[1]。椎旁神经阻滞当前应用比较多，在临床上的应用具有对血流动力学影响小、不良反应发生率低等特点[2]。其中……