PDF(Pubmed)
Abstract：
BACKGROUND: Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer (LC). This is achieved using either a thoracic paravertebral block (TPVB) or sufentanil (SUF)-based multimodal analgesia. However, the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction (POCD) remain unclear.
OBJECTIVE: To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.
METHODS: This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023. Patients receiving SUF-based multimodal analgesia (n = 50) and patients receiving TPVB + SUF-based multimodal analgesia (n = 57) were assigned to the control group and TPVB group, respectively. We compared the Ramsay Sedation Scale and visual analog scale (VAS) scores at rest and with cough between the two groups at 2, 12, and 24 h after surgery. Serum levels of epinephrine (E), angio-tensin II (Ang II), norepinephrine (NE), superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and S-100 calcium-binding protein β (S-100β) were measured before and 24 h after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery and at 3 and 5 days after surgery, and the occurrence of POCD was monitored for 5 days after surgery. Adverse reactions were also recorded.
RESULTS: There were no significant time point, between-group, and interaction effects in Ramsay sedation scores between the two groups (P > 0.05). Significantly, there were notable time point effects, between-group differences, and interaction effects observed in VAS scores both at rest and with cough (P < 0.05). The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased (P < 0.05). The TPVB group had lower VAS scores than the control group at 2, 12, and 24 h after surgery (P < 0.05). The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group (P < 0.05). The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery (P < 0.05). Both groups had elevated serum E, Ang II, and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels, with better indices in the TPVB group (P < 0.05). Marked elevations in serum levels of VEGF, TGF-β1, TNF-α, and S-100β were observed in both groups at 24 h after surgery, with lower levels in the TPVB group than in the control group (P < 0.05).
CONCLUSIONS: TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC, enhances analgesic effects, reduces postoperative stress response, and inhibits postoperative increases in serum VEGF, TGF-β1, TNF-α, and S-100β levels. This scheme also reduced POCD and had a high safety profile.
OBJECTIVE: To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.
METHODS: This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023. Patients receiving SUF-based multimodal analgesia (n = 50) and patients receiving TPVB + SUF-based multimodal analgesia (n = 57) were assigned to the control group and TPVB group, respectively. We compared the Ramsay Sedation Scale and visual analog scale (VAS) scores at rest and with cough between the two groups at 2, 12, and 24 h after surgery. Serum levels of epinephrine (E), angio-tensin II (Ang II), norepinephrine (NE), superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and S-100 calcium-binding protein β (S-100β) were measured before and 24 h after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery and at 3 and 5 days after surgery, and the occurrence of POCD was monitored for 5 days after surgery. Adverse reactions were also recorded.
RESULTS: There were no significant time point, between-group, and interaction effects in Ramsay sedation scores between the two groups (P > 0.05). Significantly, there were notable time point effects, between-group differences, and interaction effects observed in VAS scores both at rest and with cough (P < 0.05). The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased (P < 0.05). The TPVB group had lower VAS scores than the control group at 2, 12, and 24 h after surgery (P < 0.05). The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group (P < 0.05). The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery (P < 0.05). Both groups had elevated serum E, Ang II, and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels, with better indices in the TPVB group (P < 0.05). Marked elevations in serum levels of VEGF, TGF-β1, TNF-α, and S-100β were observed in both groups at 24 h after surgery, with lower levels in the TPVB group than in the control group (P < 0.05).
CONCLUSIONS: TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC, enhances analgesic effects, reduces postoperative stress response, and inhibits postoperative increases in serum VEGF, TGF-β1, TNF-α, and S-100β levels. This scheme also reduced POCD and had a high safety profile.
摘要：
背景：术后疼痛管理和认知功能保留对于接受胸腔镜肺癌（LC）手术的患者至关重要。这是使用胸椎旁阻滞（TPVB）或基于舒芬太尼（SUF）的多模式镇痛来实现的。然而,两者联合使用对术后疼痛和术后认知功能障碍(POCD)的疗效和影响尚不清楚.
目的：探讨TPVB联合SUF为基础的多模式镇痛在胸腔镜根治术LC患者中的镇痛效果及对POCD的影响，以优化术后疼痛管理，改善患者预后。
方法：本回顾性分析纳入郑州大学附属肿瘤医院和河南省肿瘤医院2021年5月至2023年1月行胸腔镜下LC根治术的107例患者。将接受基于SUF的多模式镇痛的患者(n=50)和接受基于TPVB+SUF的多模式镇痛的患者(n=57)分为对照组和TPVB组,分别。我们比较了两组患者在术后2、12和24h休息和咳嗽时的Ramsay镇静量表和视觉模拟量表（VAS）评分。血清肾上腺素水平（E），血管紧张素II（AngII），去甲肾上腺素(NE),超氧化物歧化酶（SOD），血管内皮生长因子（VEGF），转化生长因子-β1（TGF-β1），肿瘤坏死因子-α(TNF-α),术前和术后24h测定S-100钙结合蛋白β（S-100β）。在手术前1天以及手术后3天和5天进行简易精神状态检查（MMSE），术后5天监测POCD的发生情况。还记录了不良反应。
结果：没有明显的时间点，组间,两组Ramsay镇静评分及交互作用(P>0.05)。重要的是,有显著的时间点效应，组间差异，静息和咳嗽时VAS评分的交互作用（P<0.05）。术后12、24h静息及咳嗽时的VAS评分均低于术后2h,且随着术后时间的增加而逐渐降低(P<0.05)。TPVB组术后2、12、24h的VAS评分均低于对照组(P<0.05)。TPVB组术后第1天和第3天的MMSE评分明显高于对照组(P<0.05)。术后5d内TPVB组POCD发生率明显低于对照组(P<0.05)。两组均有血清E升高,AngII,术后24h血清SOD水平与术前相比降低,TPVB组各项指标均较好(P<0.05)。血清VEGF水平显著升高，TGF-β1,TNF-α,两组术后24h观察S-100β,TPVB组低于对照组(P<0.05)。
结论：TPVB联合SUF为基础的多模式镇痛进一步缓解了胸腔镜下LC根治术患者的疼痛，增强镇痛效果，减少术后应激反应，并抑制术后血清VEGF的增加，TGF-β1,TNF-α,和S-100β水平。该方案还降低了POCD并具有高安全性。
目的：探讨TPVB联合SUF为基础的多模式镇痛在胸腔镜根治术LC患者中的镇痛效果及对POCD的影响，以优化术后疼痛管理，改善患者预后。
方法：本回顾性分析纳入郑州大学附属肿瘤医院和河南省肿瘤医院2021年5月至2023年1月行胸腔镜下LC根治术的107例患者。将接受基于SUF的多模式镇痛的患者(n=50)和接受基于TPVB+SUF的多模式镇痛的患者(n=57)分为对照组和TPVB组,分别。我们比较了两组患者在术后2、12和24h休息和咳嗽时的Ramsay镇静量表和视觉模拟量表（VAS）评分。血清肾上腺素水平（E），血管紧张素II（AngII），去甲肾上腺素(NE),超氧化物歧化酶（SOD），血管内皮生长因子（VEGF），转化生长因子-β1（TGF-β1），肿瘤坏死因子-α(TNF-α),术前和术后24h测定S-100钙结合蛋白β（S-100β）。在手术前1天以及手术后3天和5天进行简易精神状态检查（MMSE），术后5天监测POCD的发生情况。还记录了不良反应。
结果：没有明显的时间点，组间,两组Ramsay镇静评分及交互作用(P>0.05)。重要的是,有显著的时间点效应，组间差异，静息和咳嗽时VAS评分的交互作用（P<0.05）。术后12、24h静息及咳嗽时的VAS评分均低于术后2h,且随着术后时间的增加而逐渐降低(P<0.05)。TPVB组术后2、12、24h的VAS评分均低于对照组(P<0.05)。TPVB组术后第1天和第3天的MMSE评分明显高于对照组(P<0.05)。术后5d内TPVB组POCD发生率明显低于对照组(P<0.05)。两组均有血清E升高,AngII,术后24h血清SOD水平与术前相比降低,TPVB组各项指标均较好(P<0.05)。血清VEGF水平显著升高，TGF-β1,TNF-α,两组术后24h观察S-100β,TPVB组低于对照组(P<0.05)。
结论：TPVB联合SUF为基础的多模式镇痛进一步缓解了胸腔镜下LC根治术患者的疼痛，增强镇痛效果，减少术后应激反应，并抑制术后血清VEGF的增加，TGF-β1,TNF-α,和S-100β水平。该方案还降低了POCD并具有高安全性。
