艾司氯胺酮复合超声引导下神经阻滞在非小细胞肺癌胸腔镜下根治术后的镇痛作用探讨

Exploring the analgesic role of esketamine combined with ultrasound-guided nerve block after thoracoscopic radical operation for non-small cell lung cancer

摘要:

目的 探讨艾司氯胺酮复合超声引导下神经阻滞在非小细胞肺癌（NSCLC）胸腔镜下根治术后的镇痛作用。方法 选取2022年2月－2023年12月拟在该院行胸腔镜肺癌根治术的NSCLC患者130例，随机分为常规组和观察组，各65例。常规组实施术后常规镇痛和超声引导下神经阻滞，观察组在此基础上增加艾司氯胺酮。比较两组患者视觉模拟评分法（VAS）评分、疼痛介质［多巴胺（DA）、P物质（SP）和5-羟色胺（5-HT）］、应激反应指标［去甲肾上腺素（NE）、皮质醇（Cor）和前列腺素E2（PGE2）］和不良反应的差异。结果 两组患者术后VAS评分的组间效应和时间效应比较，差异均有统计学意义（P < 0.05），但交互效应比较，差异无统计学意义（P > 0.05）。当控制时间因素进行比较时，观察组术后6、12和24 h的VAS评分明显低于常规组，差异均有统计学意义（P < 0.05）；当控制组间因素进行比较时，两组患者VAS评分随时间变化呈先升高后降低趋势，且各时间点比较，差异均有统计学意义（P < 0.05）。两组患者DA、5-HT、SP、NE、Cor和PGE2水平的组间效应和时间效应比较，差异均有统计学意义（P < 0.05），但交互效应比较，差异无统计学意义（P > 0.05）。当控制时间因素进行比较时，观察组术后24 h的DA、5-HT、SP、NE、Cor和PGE2水平明显低于常规组，差异均有统计学意义（P < 0.05）；当控制组间因素进行比较时，两组患者DA、5-HT、SP、NE、Cor和PGE2水平随时间变化呈先升高后降低趋势，且各时间点比较，差异均有统计学意义（P < 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P > 0.05）。结论 将艾司氯胺酮复合超声引导下神经阻滞应用于NSCLC胸腔镜下根治术后镇痛，能有效地减轻术后疼痛和应激反应，且不会增加不良反应的发生风险。值得应用于临床。

Abstract:

Objective To explore the analgesic role of esketamine combined with ultrasound-guided nerve block after thoracoscopic radical operation for non-small cell lung cancer (NSCLC).Methods 130 NSCLC patients who were scheduled to undergo thoracoscopic radical resection of lung cancer in this hospital from February 2022 to December 2023 were selected and randomly divided into a conventional group and an observation group, with 65 cases in each group. The conventional group received postoperative conventional analgesia and ultrasound-guided nerve block, while the observation group added esketamine on this basis. The visual analogue scale (VAS) scores, pain mediators [dopamine (DA), substance P (SP), and 5-hydroxytryptamine (5-HT)], stress response indicators [norepinephrine (NE), cortisol (Cor), and prostaglandin E2 (PGE2)] and adverse reactions of the two groups of patients were compared.Results There were statistically significant differences in the intergroup and time effects of the VAS scores after surgery between the two groups of patients (P < 0.05), but there was no statistically significant difference in the interaction effect (P > 0.05). When the time factor was controlled for comparison, the VAS scores of the observation group at 6, 12 and 24 h after the operation were significantly lower than those of the control group, and the differences were statistically significant (P < 0.05). When controlling for the group factors, the VAS scores of both groups of patients showed a trend of first increasing and then decreasing over time, and the differences at each time point were statistically significant (P < 0.05). The comparisons of the intergroup and time effects of DA, 5-HT, SP, NE, Cor and PGE2 levels between the two groups of patients showed statistically significant differences (P < 0.05), but the comparison of the interaction effect showed no statistically significant difference (P > 0.05). When the time factor was controlled for comparison, the levels of DA, 5-HT, SP, NE, Cor and PGE2 in the observation group 24 h after the operation were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). When controlling for the group factors, the levels of DA, 5-HT, SP, NE, Cor and PGE2 in the two groups showed a trend of first increasing and then decreasing over time, and the differences at each time point were statistically significant (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (P > 0.05).Conclusion The application of esketamine combined with ultrasound-guided nerve block for postoperative analgesia after thoracoscopic radical resection of NSCLC can effectively alleviate postoperative pain and stress response, and does not increase the risk of adverse reactions. It is worth applying in clinical practice.