肋间神经阻滞复合全麻联合静脉自控镇痛对胸腔镜肺大疱切除术患者术后镇痛效果及恢复情况的影响

摘要 目的：探讨在胸腔镜肺大疱切除术中应用肋间神经阻滞复合全麻联合静脉自控镇痛的术后镇痛效果及患者恢复情况。方法：研究对象选取进行胸腔镜肺大疱切除术的80例患者，依据简单数字表法分为对照组和观察组，每组各40例。对照组接受全麻联合静脉自控镇痛，观察组在此基础上复合肋间神经阻滞，比较两组术后镇痛效果及恢复情况。结果：与术前比，术后12 h、24 h两组患者的CD4⁺、CD4⁺/CD8⁺均先降低后升高，且观察组各时间点均高于对照组；两组患者的CD8⁺均先升高后降低，且观察组各时间点均低于对照组（P<0.05）。术后24 h、48 h，观察组比对照组在镇痛泵按压次数和输注镇痛药物总量有减少（P<0.05）。与对照组比，观察组患者的术毕到拔管时间、下床活动时间、住院时间均更短（P<0.05）。与对照组（22.50%、20.00%）比，观察组患者的并发症、不良反应总发生率（2.50%、5.00%）更低（P<0.05）。结论：在胸腔镜肺大疱切除术中应用肋间神经阻滞复合全麻联合静脉自控镇痛，取得了显著的镇痛成效，不仅能够减轻患者的术后疼痛，还能减轻机体免疫抑制，同时不增加并发症和不良反应发生风险，临床应用安全性较高。

Effect of Intercostal Nerve Block Combined with General Anesthesia and Patient-controlled Intravenous Analgesia on Postoperative Analgesia and Recovery of Patients Undergoing Thoracoscopic Bullectomy

ABSTRACT Objective: To explore the postoperative analgesic effect and patient recovery of intercostal nerve block combined with general anesthesia and patient-controlled intravenous analgesia in thoracoscopic bullectomy. Methods: The subjects were selected from 80 patients who underwent thoracoscopic bullectomy. They were divided into control group and observation group according to simple digital table method, with 40 patients in each group. The control group received general anesthesia combined with patient-controlled intravenous analgesia, and the observation group combined with intercostal nerve block on this basis to compare the postoperative analgesia effect and recovery of the two groups. Results: Compared with pre-operation, the CD4⁺ and CD4⁺/CD8⁺ of patients in the two groups decreased at first and then increased at 24 hours after operation, and the observation group was higher than the control group at all time points; The CD8⁺ of patients in both groups increased first and then decreased, and the observation group was lower than the control group at all time points(P<0.05). At 24 and 48 hours after operation, the number of analgesic pump pressure and the total amount of analgesic drug infusion in the observation group were decreased compared with the control group(P<0.05). Compared with the control group, the time from the end of operation to extubation, the time to get out of bed and the time to stay in hospital were shorter in the observation group(P<0.05). Compared with the control group (22.50%, 20.00%), the total incidence of complications and adverse reactions in the observation group (2.50%, 5.00%) was lower (P<0.05). Conclusion: The application of intercostal nerve block combined with general anesthesia combined with patient-controlled intravenous analgesia in thoracoscopic bullectomy has achieved remarkable analgesic effect, which can not only reduce the postoperative pain of patients, but also reduce the body''s immunosuppression, without increasing the risk of complications and adverse reactions. The clinical application is safe.