CAJ | 학술논문

目的：评价胸椎旁神经阻滞（TPVB）用于胸腔镜下肺癌根治术的临床效果。方法将40例择期拟在全身麻醉下行胸腔镜下肺癌根治术的患者按随机数字表法分为2组：单纯全身麻醉组（G 组）和 TPVB 复合全身麻醉组（GP 组），每组20例。2组患者均选择静脉麻醉诱导气管插管，采用静吸复合麻醉维持。GP 组于麻醉诱导前在神经刺激器引导下行 T4—5椎旁神经阻滞；G 组麻醉诱导前不给予任何处理。2组患者均于术毕使用舒芬太尼自控静脉镇痛，分别于术后2、24、48 h 时记录镇痛情况（VAS 评分）、术后24及48 h 患者静脉自控（PCI）泵按压次数以及背景输注总量；观察2组患者术后不良反应（恶心、呕吐、嗜睡及呼吸抑制）的发生率。并分别于术前及术后24 h时采集患者静脉血2 mL，采用 Elisa 法检测血清血管内皮生长因子（VEGF）和基质金属蛋白酶-9（MMP-9）的水平。结果GP 组术后2、24 h 的 VAS 评分，术后24、48 h PCI 泵按压次数及背景输注总量均明显低于 G 组（均 P ＜0．05）；2组48 h 时 VAS 评分比较差异无统计学意义（P ＞0．05）。G 组术后不良反应发生率为35．0％，GP 组为30．0％，2组比较差异无统计学意义（P ＞0．05）。2组均未出现呼吸抑制。2组术前血清 VEGF 及 MMP-9水平比较差异无统计学意义（P ＞0．05）；术后24 h 均较术前明显升高，G 组较 GP 组升高的更明显（均 P ＜0．05）。结论与单纯全身麻醉比较，PTVB 复合全身麻醉用于胸腔镜下肺癌根治术患者术后镇痛效果佳，并可抑制患者术后血清 VEGF 和 MMP-9水平的升高。
목적：평개흉추방신경조체（TPVB）용우흉강경하폐암근치술적림상효과。방법장40례택기의재전신마취하행흉강경하폐암근치술적환자안수궤수자표법분위2조：단순전신마취조（G 조）화 TPVB 복합전신마취조（GP 조），매조20례。2조환자균선택정맥마취유도기관삽관，채용정흡복합마취유지。GP 조우마취유도전재신경자격기인도하행 T4—5추방신경조체；G 조마취유도전불급여임하처리。2조환자균우술필사용서분태니자공정맥진통，분별우술후2、24、48 h 시기록진통정황（VAS 평분）、술후24급48 h 환자정맥자공（PCI）빙안압차수이급배경수주총량；관찰2조환자술후불량반응（악심、구토、기수급호흡억제）적발생솔。병분별우술전급술후24 h시채집환자정맥혈2 mL，채용 Elisa 법검측혈청혈관내피생장인자（VEGF）화기질금속단백매-9（MMP-9）적수평。결과GP 조술후2、24 h 적 VAS 평분，술후24、48 h PCI 빙안압차수급배경수주총량균명현저우 G 조（균 P ＜0．05）；2조48 h 시 VAS 평분비교차이무통계학의의（P ＞0．05）。G 조술후불량반응발생솔위35．0％，GP 조위30．0％，2조비교차이무통계학의의（P ＞0．05）。2조균미출현호흡억제。2조술전혈청 VEGF 급 MMP-9수평비교차이무통계학의의（P ＞0．05）；술후24 h 균교술전명현승고，G 조교 GP 조승고적경명현（균 P ＜0．05）。결론여단순전신마취비교，PTVB 복합전신마취용우흉강경하폐암근치술환자술후진통효과가，병가억제환자술후혈청 VEGF 화 MMP-9수평적승고。
ABSTRACT:Objective To investigate the clinical efficacy of thoracic paravertebral block (TPVB)in patients undergoing thoracoscopic radical surgery for lung cancer.Methods Forty lung cancer patients scheduled for thoracoscopic radical surgery were randomly assigned to receive either general anesthesia alone(group G,n = 20)or in combination with TPVB(group GP,n =20).All patients received inhalational agents for maintenance of anesthesia after intravenous anes-thesia induction and tracheal intubation.Patients in group GP underwent TPVB guided by nerve stimulator at T4-5 before anesthesia induction.Patients in group G received no treatment before anesthesia induction.After operation,patients received patient-controlled intravenous analgesia (PCIA)with sufentanil.The visual analogue scale(VAS)scores were recorded 2,24 and 48 hours after operation.The times of pressing patient-controlled intravenous(PCI)pump and the volume of background infusion were recorded 24 and 48 hours after operation.The incidence of postopera-tive adverse reactions (nausea,vomiting,lethargy and respiratory depression)was observed in both groups.Venous blood samples(2 mL)were collected before and 24 hours after operation,and serum levels of vascular endothelial growth factor(VEGF)and matrix metalloproteinase-9(MMP-9)were measured by ELISA.Results Compared with group G,VAS scores decreased 2 and 24 hours after operation and times of pressing PCI pump and volume of background infusion re-duced 24 and 48 hours after operation in group GP(P <0.05).The difference in VAS scores was not significant between the two groups 48 hours after operation(P >0.05).Furthermore,the inci-dence of postoperative adverse reactions in group G(35.0%)was not significantly different from that in group GP(30.0%)(P >0.05).No respiratory depression occurred in both groups.Before operation,no significant differences in serum levels of VEGF and MMP-9 were found between the two groups(P >0.05).,However,the levels of VEGF and MMP-9 significantly increased after operation,and the increase in group G was more obvious than that in group GP(P <0.05).Con-clusion The combination of TPVB and general anesthesia is superior to general anesthesia alone for postoperative analgesia and inhibition of serum VEGF and MMP-9 levels in patients undergo-ing thoracoscopic radical surgery for lung cancer.