术前切口部位超前镇痛对开胸手术患者术后恢复的影响

李东，杜宁，孙欣，刘大鹏，张云锋，任宏

（西安交通大学第一附属医院胸外2 科，陕西 西安，710061）

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摘要：

目的 探讨术前切口部位超前镇痛对开胸手术患者术后恢复的影响。方法 随机将70 例我院收治的择期进行开胸手术的 患者分为试验组（35 例）和对照组（35 例）。全身麻醉后，试验组沿手术切口给予罗哌卡因进行局部浸润麻醉，对照组给予同等 剂量生理盐水。于不同时间点检测两组患者血清中TNF-α、IL-6、IL-10、hs原CRP 及PCT 的表达，VAS 评分，HR、MAP 和PaCO2。
结果随着术后时间的延长，两组患者的VAS 评分均呈下降趋势，且试验组患者T2～T5 时的VAS 评分均低于对照组（P<0.05）。随 着术后时间的延长，两组患者的血清TNF-α、IL-6、hs-CRP 和PCT 水平呈升高趋势，且试验组患者T2~T5 时的TNF-α、IL-6、hs-CRP 和PCT 水平低于对照组，IL-10 水平高于对照组（P<0.05）。试验组患者T2~T5 时的HR、MAP 和PaCO2 较平稳，而对照组的 HR、MAP 和PaCO2 先升高后降低，且T2~T5 时试验组的上述指标均优于对照组（P<0.05）。结论 开胸手术患者术前给予超前镇 痛不仅能够获得良好的术后镇痛效果，而且能够降低术后炎性反应的发生，减少术后呼吸和循环系统并发症的发生。

关键词：开胸手术；炎性细胞因子；超前镇痛

中图分类号：R614文献标志码：A文章编号：2096-1413(2018)1-0040-03

Clinical effect of preoperative incisional preemptive analgesia on postoperative recovery in patients underwent thoracotomy
LI Dong, DU Ning, SUN Xin, LIU Da-peng, ZHANG Yun-feng, REN Hong
(Second Thoracic Surgery Department, the First Affiliated Hospital of Xi``an Jiaotong University, Xi``an 710061, China)

ABSTRACT: Objective To investigate the effect of preoperative incisional preemptive analgesic on postoperative recovery in patients underwent thoracotomy. Methods A total of 70 patients underwent elective thoracotomy in our hospital were randomly divided into experimental group (35 cases) and control group (35 cases). After general anesthesia, the experimental group received preoperative incisional preemptive analgesic with ropivacaine and the control group with the same dose of normal saline. The serum levels of TNF-α, IL-6, IL-10, hs-CRP and PCT, the VAS score, HR, MAP and PaCO2 in the two groups of patients at different time points were monitored. Results With the extension of postoperative time, the VAS scores of both groups showed a downward trend, and the VAS scores from T2 to T5 in the experimental group were lower than those of the control group (P<0.05). With the extension of postoperative time, the serum TNF-α, IL-6, hs-CRP and PCT levels increased in both groups, the levels of TNF-α, IL-6, hs-CRP and PCT from T2 to T5 in the experimental group were lower than those in the control group, and the level of IL-10 was higher than that in the control group (P<0.05). The HR, MAP and PaCO2 from T2 to T5 in the experimental group were stable, while the HR, MAP and PaCO2 in the control group increased and then decreased, and those indexes from T2 to T5 in the experimental group were better than the control group (P<0.05). Conclusion Preemptive analgesia in patients underwent thoracotomy can not only obtain good postoperative analgesic effect, but also reduce the occurrence of postoperative inflammatory response and the incidence of postoperative respiratory and circulatory complications.
KEYWORDS: thoracotomy; inflammatory cytokines; preemptive analgesia

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