维生素B12为佐剂的肋间神经阻滞对胸腔镜下肺部手术患者急慢性疼痛的干预效果研究

Study on the intervention effect of intercostal nerve block with vitamin B12 as an adjuvant on acute and chronic pain in patients undergoing thoracoscopic pulmonary surgery

摘要:

目的 探讨维生素B12为佐剂的肋间神经阻滞（INB）对胸腔镜下肺部手术患者急慢性疼痛的干预效果。方法 选取2020年6月－2022年6月于该院行胸腔镜下肺部手术的患者90例，根据麻醉诱导后INB采用麻醉增效剂的不同，将患者分为A组、B组和C组，各30例。A组予以肋间INB（0.4%罗哌卡因），B组常规诱导后予以肋间INB（0.4%罗哌卡因+地塞米松），C组常规诱导后亦予以肋间INB（0.4%罗哌卡因+维生素B12）。比较3组患者的术后疼痛程度、生命体征、围手术期舒芬太尼用量和术后拔管时间。结果 B组和C组T₁、T₂、T₃、T₄和T₅时点的心率（HR）、收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）明显低于A组，差异均有统计学意义（P < 0.05）。B组和C组的围手术期舒芬太尼用量明显少于A组，术后拔管时间明显短于A组，差异均有统计学意义（P < 0.05）。B组和C组T₆、T₇、T₈、T₉、T₁₀、T₁₁和T₁₂时点的视觉模拟评分法（VAS）评分明显低于A组，C组T₉、T₁₀和T₁₁时点的VAS评分明显低于B组，差异均有统计学意义（P < 0.05）。B组和C组术后1、3和6个月的VAS评分明显低于A组，C组术后3和6个月的VAS评分明显低于B组，差异均有统计学意义（P < 0.05）。结论 维生素B12为佐剂的INB用于胸腔镜下肺部手术的干预，临床效果较好，可减轻患者急慢性疼痛，稳定生命体征，减少围手术期舒芬太尼用量，缩短术后拔管时间，值得应用于临床。

Abstract:

Objective To explore the intervention effect of intercostal nerve block (INB) with vitamin B12 as an adjuvant on acute and chronic pain in patients undergoing thoracoscopic pulmonary surgery.Methods 90 patients who underwent thoracoscopic pulmonary surgery in the hospital from June 2020 to June 2022 were selected. According to the different anesthetic enhancers used for INB after anesthesia induction, the patients were divided into group A, group B and group C, with 30 cases in each group. Group A was given intercostal INB (0.4% ropivacaine), group B was given intercostal INB (0.4% ropivacaine + dexamethasone) after conventional induction, and group C was given intercostal INB (0.4% ropivacaine + vitamin B12) after conventional induction. The postoperative pain degree, vital signs, perioperative sufentanil dosage and postoperative extubation time of the three groups were compared.Results The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at time points T₁, T₂, T₃, T₄, and T₅ time points in group B and group C were significantly lower than those in group A, and the differences were statistically significant (P < 0.05). The perioperative sufentanil dosage in group B and group C was significantly less than that in group A, and the postoperative extubation time was significantly shorter than that in group A. The differences were statistically significant (P < 0.05). The visual analogue scale (VAS) scores of group B and group C at time points of T₆, T₇, T₈, T₉, T₁₀, T₁₁ and T₁₂ were significantly lower than those of group A. The VAS scores of group C at time points T₉, T₁₀ and T₁₁ were significantly lower than those of group B. The differences were statistically significant (P < 0.05). The VAS scores of group B and group C at 1, 3 and 6 months after surgery were significantly lower than those of group A, and the VAS scores of group C at 3 and 6 months after surgery were significantly lower than those of group B. The differences were statistically significant (P < 0.05).Conclusion Vitamin B12 adjuvant INB is used in the intervention of thoracoscopic pulmonary surgery, with good clinical effects. It can relieve acute and chronic pain in patients, stabilize vital signs, reduce the dosage of sufentanil during the perioperative period, and shorten the extubation time after surgery. It is worthy of clinical application.