布托啡诺预处理联合超声引导下胸椎旁神经阻滞麻醉对胸腔镜下肺癌根治术患者镇痛效果及应激反应的影响

摘要 目的：探究布托啡诺预处理联合超声引导下胸椎旁神经阻滞麻醉（TPVB）对胸腔镜下肺癌根治术患者镇痛效果及应激反应的影响。方法：选取2021年5月至2022年6月我院60例肺癌患者，采用随机数字表法分为观察组（n=30）和对照组（n=30）。两组均给予静脉麻醉，术后均采用静脉自控镇痛（PCIA），观察组术前在超声引导下行TPVB，并给予布托啡诺预处理。比较两组血流动力学、麻醉效果、术后疼痛情况、应激反应、不良反应发生情况。结果：与T₀时刻比较，两组T₁时刻心率（HR）、平均动脉压（MAP）均下降（P<0.05）；与T₁时刻比较，两组T₂时刻HR、MAP均升高（P<0.05）；与对照组比较，观察组T₂、T₃时刻HR、MAP均较低（P<0.05）。观察组丙泊酚、瑞芬太尼用量、拔管时间、PCIA使用次数较对照组更低、更短、更少（P<0.05）。术后8 h、12 h、24 h，观察组静息时、咳嗽时疼痛程度均低于对照组（P<0.05）。术后，两组肾上腺素（E）、皮质醇（Cor）、促肾上腺皮质激素（ACTH）均升高（P<0.05），但观察组E、Cor、ACTH均低于对照组（P<0.05）。两组不良反应总发生率比较无明显差异（P＞0.05）。结论：胸腔镜下肺癌根治术患者使用布托啡诺预处理联合超声引导下TPVB能控制血流动力学与阿片类药物总用量，缩短拔管时间，还能减轻术后疼痛与应激反应。

Influence of Butorphanol Pretreatment Combined with Ultrasound-guided Thoracic Paravertebral Nerve Block Anesthesia on Analgesic Effect and Stress Response in Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

ABSTRACT Objective: To explore the influence of butorphanol pretreatment combined with ultrasound-guided thoracic paravertebral nerve block anesthesia (TPVB) on analgesic effect and stress response in patients undergoing thoracoscopic radical resection of lung cancer. Methods: Sixty patients with lung cancer in our hospital were selected from May 2021 to June 2022 and were classified into observation group (n=30) and control group (n=30) by random number table method. Both groups received intravenous anesthesia and were treated with patient-controlled intravenous analgesia (PCIA) after surgery, and the observation group performed ultrasound-guided TPVB before surgery and was given butorphanol pretreatment. The hemodynamics, anesthetic effect, postoperative pain status, stress response and occurrence of adverse reactions were compared between the two groups. Results: Compared with T₀, the heart rate (HR) and mean arterial pressure (MAP) in the two groups were decreased at T₁ (P<0.05). The HR and MAP were increased at T₂ in the two groups compared with those at T₁ (P<0.05). The HR and MAP at T₂ and T₃ in observation group were lower compared to control group (P<0.05). The propofol dosage, remifentanil dosage, extubation time and PCIA use frequency in observation group were lower, shorter or less than those in control group(P<0.05). At 8 h, 12 h and 24 h after surgery, the pain degrees at rest and cough in observation group were milder than those in control group(P<0.05). After surgery, the levels of epinephrine (E), cortisol (Cor) and adrenocorticotropic hormone (ACTH) were risen in the two groups (P<0.05), but the observation group had lower levels (P<0.05). There was no significant difference in the total incidence rate of adverse reactions between the two groups(P>0.05). Conclusion: Butorphanol pretreatment combined with ultrasound-guided TPVB can control the hemodynamics and total dosage of opioids of patients undergoing thoracoscopic radical resection of lung cancer, shorten the extubation time, and relieve the postoperative pain and stress response.