2024 年第 9 期 第 0 卷

超声引导下椎旁神经阻滞联合胸内迷走神经阻滞用于胸腔镜手术快速康复的效果研究

The effect of ultrasound-guided paravertebral nerve block combined with intrathoracic vagus nerve block on rapid recovery after thoracoscopic surgery

作者：邱荣恩1兰允平1李晋2张艳清2曾睿峰3

英文作者：Qiu Rongen1 Lan Yunping1 Li Jin2 Zhang Yanqing2 Zeng Ruifeng3

单位：1温州医科大学附属衢州医院衢州市人民医院麻醉科，衢州324000；2浙江省开化县人民医院麻醉科，衢州324300；3温州医科大学附属第二医院麻醉科，温州325027

英文单位：1Department of Anesthesiology Quzhou Hospital Affiliated to Wenzhou Medical University Quzhou City People′s Hospital Quzhou 324000 China; 2Department of Anesthesiology Kaihua County People′s Hospital Zhejiang Province Quzhou 324300 China; 3Department of Anesthesiology Wenzhou Medical University Affiliated Second Hospital Wenzhou 325027 China

关键词：胸腔镜手术；椎旁神经阻滞；迷走神经阻滞；快速康复；疼痛

英文关键词：Thoracoscopicsurgery;Paravertebralnerveblock;Vagusnerveblock;Rapidrecovery;Pain

• 摘要：

• 目的 探讨超声引导下椎旁神经阻滞（TPVB）联合胸内迷走神经阻滞用于胸腔镜手术快速康复的效果。方法 选取2022年2月至2023年1月于衢州市人民医院接受胸腔镜手术的66例肺癌患者为研究对象，采用随机数字表法分为对照组和观察组，各33例。2组均接受电视辅助胸腔镜肺癌手术，对照组采用双腔支气管插管全身麻醉，观察组采用超声引导下TPVB联合胸内迷走神经阻滞，实施不插管静脉麻醉。观察2组患者术后恢复情况、不同时间节点平均动脉压、心率、疼痛程度以及术后并发症发生率。结果 观察组术后首次进食时间、住院时间均短于对照组，手术开始30 min 动脉血二氧化碳分压高于对照组（均P<0.001）。手术开始30 min、术毕即刻，对照组心率、平均动脉压均高于麻醉诱导前（均P＜0.05），观察组心率、平均动脉压与麻醉诱导前比较差异均无统计学意义（均P＞0.05），但均低于对照组［心率：（75±8）次/min比（81±7）次/min、（76±8）次/min比（83±10）次/min；平均动脉压：（81±9）mmHg（1 mmHg=0.133 kPa）比（90±9）mmHg、（82±8）mmHg比（93±10）mmHg］（均P＜0.05）。术前30 min，2组视觉模拟量表评分比较差异无统计学意义（P>0.05），术后1、6、12、24、48 h，观察组视觉模拟量表评分均低于对照组（均P<0.05）。观察组并发症发生率低于对照组［6.1%（2/33）比24.2%（8/33）］（χ2=4.243，P=0.039）。结论 相比较于双腔支气管插管全身麻醉方式，对于接受电视辅助胸腔镜的患者予以超声引导下TPVB联合胸内迷走神经阻滞可避免血压和心率的波动，减轻术后疼痛，加快术后恢复，降低术后并发症的发生率。

• Objective To investigate the effect of ultrasound-guided paravertebral nerve block (TPVB) combined with intrathoracic vagus nerve block on rapid recovery after thoracoscopic surgery. Methods A total of 66 patients with lung cancer who underwent thoracoscopic surgery in Quzhou City People′s Hospital from February 2022 to January 2023 were selected as the research objects, and they were divided into the control group and the observation group by random number table method, with 33 cases in each group. Both groups received video-assisted thoracoscopic surgery for lung cancer. The control group was given general anesthesia with double-lumen bronchial intubation, and the observation group was given non-intubation intravenous anesthesia with ultrasound-guided TPVB combined with intrathoracic vagus nerve block. The postoperative recovery, mean arterial pressure, heart rate, degree of pain and incidence of postoperative complications were observed between the two groups. Results The first feeding time and hospital stay of the observation group were shorter than those of the control group, and the partial pressure of carbon dioxide in arterial blood 30 min after the operation was higher than that of the control group (all P<0.001). The heart rate and mean arterial pressure in the control group were higher than those before anesthesia induction 30 min after operation and immediately after operation (both P<0.05); but there were no significant differences in heart rate and mean arterial pressure before and after anesthesia induction in the observation group (all P>0.05); and the heart rate and mean arterial pressure in the observation group were lower than those in the control group ［heart rate: (75±8)times/min vs (81±7)times/min, (76±8)times/min vs (83±10)times/min; mean arterial pressure: (81±9)mmHg vs (90±9)mmHg, (82±8)mmHg vs (93±10)mmHg］(all P<0.05). There was no significant difference in visual analogue scale score between the two groups at 30 min before operation (P>0.05). At 1, 6, 12, 24 and 48 h after operation, the visual analogue scale scores of the observation group were lower than those of the control group (all P<0.05). The incidence of complications in the observation group was lower than that in the control group ［6.1%(2/33) vs 15.2%(5/33)］(χ2=4.243, P=0.039). Conclusion Compared with the double-lumen endotracheal intubation general anesthesia method, for patients undergoing video-assisted thoracoscopic surgery, ultrasound-guided TPVB combined with intrapleural vagus nerve block can avoid fluctuations in blood pressure and heart rate, reduce postoperative pain, accelerate postoperative recovery, and reduce the incidence of postoperative complications.