新疆医科大学学报

目的 研究加速康复外科(enhanced recovery after surgery,ERAS)模式下竖脊肌与神经阻滞麻醉对电视辅助胸腔镜手术（video assisted thoracic surgery,VATS）胸科手术肺结核患者镇痛效果、细胞因子及肺部并发症的影响。方法 以新疆医科大学第八附属医院麻醉科2020年1月-2021年6月100例拟行胸腔镜肺切除择期手术患者为研究对象，采用随机数字法分为对照组及实验组，每组50例，两组患者均进行电视胸腔镜下肺切除术，对照组采用肋间神经阻滞麻醉，实验组采用超声引导下竖脊肌平面阻滞镇痛，比较两组患者术后视觉模拟评分法(Visual Analogue Scale/Score,VAS)评分、血清白细胞介素-6(IL-6)水平、睡眠障碍及肺部并发症的差异。结果 与对照组比较，实验组术后4、6、12、24 h静息疼痛VAS评分及咳嗽时VAS评分均降低，差异有统计学意义（P<0.05）。与对照组患者血清中IL-6水平（65.33±4.66）pg/mL比较，实验组术前血清中IL-6水平（64.09±5.20）pg/mL差异无统计学意义（t=1.256,P=0.212）；与对照组患者术后3 d血清IL-6水平（172.31±14.00）pg/mL比较，实验组术后3 d患者血清IL-6水平（143.06±12.05）pg/mL水平降低，差异有统计学意义（t=11.200,P<0.001）。与本组术前比较，两组术后血清中IL-6水平均升高，差异有统计学意义（P<0.05）；与对照组比较，实验组患者术前及术后1 d睡眠障碍评分差异无统计学意义（P>0.05），实验组术后3 d及6 d患者睡眠障碍评分降低，差异有统计学意义（P<0.05）。与对照组比较，实验组患者肺部并发症（肺部感染、肺不张及呼吸衰竭）发生率降低，差异有统计学意义（χ2=3.843,P=0.049）。结论 胸腔镜肺切除择期手术患者胸腔镜下进行竖脊肌平面阻滞麻醉，可抑制血清IL-6水平，改善睡眠质量，降低肺部并发症，值得推广应用。

Objective To investigate the effect of erector spinal and nerve block anesthesia on analgesia, cytokines and pulmonary complications in patients with pulmonary tuberculosis undergoing VATS surgery under accelerated rehabilitation surgery(ERAS) mode. Methods A total of 100 patients planned to undergo elective thoracoscopic pneumonectomy in the hospital from January 2020 to June 2021 were selected as research subjects. The patients were divided into the control group and the experimental group by random number method, with 50 patients in each group. Patients in both groups received video-assisted thoracoscopic pneumonectomy, while patients in the control group received intercostal nerve block anesthesia, the experimental group used by ultrasound guided by vertical plane block analgesia,comparing with the two groups of patients of postoperative visual analogue scale method(Visual Analogue Scale/Score,VAS Score, serum level of interleukin(IL) 6, the difference between sleep disorder and pulmonary complications. Results Compared with the control group, VAS scores of the patients in the experimental group were decreased at 4, 6, 12and 24 hours after operation(P < 0.05). Compared with the control group, VAS scores at rest and cough at 4h, 6h, 12h and 24h after surgery were decreased in the experimental group(P < 0.05). Compared with(65.33±4.66) pg/mL in the control group, the preoperative serum IL-6 level in the experimental group was(64.09±5.20) pg/mL, with no statistical significance(t=1.256, P=0.212). Compared with the control group(172.31±14.00) pg/mL, the serum IL-6 level of the experimental group(143.06±12.05) pg/mL decreased 3d after operation(t=11.200, P<0.001). Compared with the preoperative level, serum IL-6 level in both groups increased after surgery(P<0.05). Compared with the control group, patients in the experimental group had sleep disturbance before and after 1d, the difference was no statistically significant(P>0.05). Compared with the control group, patients in the experimental group had sleep disturbance after 3d and6d(P<0.05). Compared with the control group, the incidence of pulmonary complications(pulmonary infection, atelectasis and respiratory failure) in the experimental group was lower, the difference was statistically significant(X2=3.843, P=0.049). Conclusion Thoracoscopic spinal plane block anesthesia can significantly inhibit serum IL-6 level, improve sleep quality and reduce pulmonary complications in patients undergoing elective thoracoscopic pulmonary resection,which is worthy for popularization and application.