摘要
目的探讨竖脊肌平面阻滞(ESPB)超前镇痛对老年胸腔镜肺癌根治术患者心肌的保护作用。方法选择在惠州市中心人民医院择期行胸腔镜肺癌根治术的老年患者40例,按照患者意愿分组,其中19例采用ESPB联合全身麻醉(观察组),21例采用单纯全身麻醉(对照组)。在两组诱导前(T0)、手术开始1 h(T1)、手术结束时(T2)及术后4 h(T3)检测患者的肌钙蛋白Ⅰ(cTnⅠ)、心型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB),并记录各时间点的平均动脉压(MAP)和心率。计量资料的组间比较采用t检验,重复测量资料采用重复测量方差分析。结果两组患者MAP、心率、cTnⅠ、H-FABP、CK-MB的差异均呈现组间效应、时间效应和交互效应(MAP:F=24.021、33.512、9.184,心率:F=10.340、46.992、3.494,cTnⅠ:F=5.354、691.994、64.177,H-FABP:F=7.906、14.067、11.560,CK-MB:F=15.926、84.106、4.116,P<0.05或0.01)。与T0时间点比较,两组患者T1、T2、T3时间点MAP、心率、H-FABP、CK-MB均出现明显变化(P<0.05),T2、T3时间点cTnⅠ出现明显变化(P<0.05)。结论老年胸腔镜肺癌根治术中应用ESPB超前镇痛,可明显降低心肌损伤相关因子水平,起到心肌保护作用。
Objective To investigate the myocardial protection effect of erector spinae plane block for preemptive analgesia in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods A total of 40 elderly patients who underwent thoracoscopic radical resection of lung cancer in Huizhou Central People's Hospital were selected.According to the wishes of patients,19 patients were treated with ESPB combined with general anesthesia(observation group),and the other 21 patients were treated with simple general anesthesia(control group).Cardiac troponinⅠ(cTnⅠ),heart-type fatty acid binding protein(H-FABP)and creatine kinase isoenzyme(CK-MB)were detected at time points before induction(T0),at the beginning of surgery(T1),at the end of surgery(T2)and at 4 h after surgery(T3),and record the mean artery pressure(MAP)and heart rate at each time point.T test was used for comparison between groups,and repeated ANOVA was used for repeated measurement data.Results The differences of MAP,heart rate,cTnⅠ,H-FABP and CK-MB between the two groups showed inter group effect,time effect and interaction effect(MAP:F=24.021,33.512,9.184,heart rate:F=10.340,46.992,3.494,cTnⅠ:F=5.354, 691.994, 64.177, H-FABP: F=7.906, 14.067, 11.560, CK-MB: F=15.926, 84.106, 4.116, P < 0.05 or P < 0.01). Compared with T0, MAP, heart rate, H-FABP and CK-MB showed significant changes at T1, T2 and T3 (P < 0.05), and cTnⅠ showed significant changes at T2 and T3 (P < 0.05). Conclusion The application of ESPB in advanced analgesia during thoracoscopic radical operation for elderly patients with lung cancer can significantly reduce the level of myocardial injury related factors and play a protective role in the myocardium.
作者
尹晓旭
江鹏
赖威远
谢国香
Yin Xiaoxu;Jiang Peng;Lai Weiyuan;Xie Guoxiang(Department of Anesthesiology,Huizhou Central People’s Hospital,Huizhou 516001,China;Department of Anesthesiology,People’s Hospital of Boluo Country,Boluo 516100,China)
出处
《中华老年病研究电子杂志》
2022年第3期46-50,共5页
Chinese Journal of Geriatrics Research(Electronic Edition)
基金
惠州市科技计划(医疗卫生)项目(2021wc0106455)。
关键词
竖脊肌平面阻滞
超前镇痛
胸腔镜
肺癌根治术
心肌损伤因子
老年人
Erector spinal muscle plane block
Preemptive analgesia
Thoracoscope
Radical surgery of lung cancer
Myocardial injury factor
Aged
