Application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy

BU Le-ye; MA Qi-gang; ZHANG Chuan-xin; HE Guang-yao

doi:10.11659/jjssx.04E024084

您当前的位置：

首页 >

文章列表页 >

Application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy

Clinical Research | 更新时间：2025-01-21

- Application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 2, Pages: 159-162(2025)
- 作者机构：
  
  六安市中医院麻醉科，安徽六安 237000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.04E024084
  CLC： R614.4
- Published：25 February 2025，
  
  Received：17 April 2024，
- 稿件说明：
移动端阅览
BU LE-YE, MA QI-GANG, ZHANG CHUAN-XIN, et al. Application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy. [J]. Journal of regional anatomy and operative surgery, 2025, 34(2): 159-162.
DOI：

BU LE-YE, MA QI-GANG, ZHANG CHUAN-XIN, et al. Application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy. [J]. Journal of regional anatomy and operative surgery, 2025, 34(2): 159-162. DOI： 10.11659/jjssx.04E024084.

摘要

目的

分析对乙酰氨基酚超前镇痛复合肋间神经阻滞在胸腔镜肺叶切除术中的应用效果。

方法

选取2021年1月至2023年9月六安市中医院收治的120例经胸腔镜行肺叶切除术的肺癌患者作为研究对象，按随机数字表法将其分为对照组和观察组，每组60例。对照组患者于麻醉诱导前给予对乙酰氨基酚超前镇痛，观察组患者在对照组的基础上复合肋间神经阻滞。比较2组患者术后3、12、24、48 h的视觉模拟量表（VAS）评分、Ramsay镇静评分及血清β-内啡肽、前列腺素E2水平；比较2组患者麻醉诱导前、拔管后的去甲肾上腺素（NE）、肾上腺素（E）、血清皮质醇（Cor）等应激反应指标及CD3

＋

、CD4

＋

、CD4

＋

/CD8

＋

等免疫功能指标；比较2组患者拔管后不良反应的发生情况。

结果

2组患者术后VAS评分随时间延长逐渐增加，Ramsay镇静评分随时间延长逐渐降低，观察组患者术后各时点VAS评分均低于对照组，Ramsay镇静评分均高于对照组，差异均有统计学意义（

0.05）。2组患者术后血清β-内啡肽、前列腺素E2水平随时间延长逐渐降低，观察组患者术后各时点血清β-内啡肽水平均高于对照组，前列腺素E2水平均低于对照组，差异均有统计学意义（

0.05）。2组患者拔管后NE、E、Cor水平均显著降低（

0.05），且观察组低于对照组（

0.05）；2组患者拔管后CD3

＋

、CD4

＋

、CD4

＋

/CD8

＋

水平均显著降低（

0.05），且观察组高于对照组（

0.05）。观察组不良反应总发生率低于对照组，差异有统计学意义(

0.05)。

结论

对乙酰氨基酚超前镇痛复合肋间神经阻滞应用于胸腔镜肺叶切除术，患者镇痛和镇静效果良好，有助于提高患者免疫功能，减少术后不良反应。

Abstract

Objective

To analyze the application effect of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy.

Methods

A total of 120 patients with lung cancer who underwent thoracoscopic lobectomy admitted to Lu'an Traditional Chinese Medicine Hospital from January 2021 to September 2023 were selected as the study objects，and they were divided into the control group and the observation group according to random number table method，with 60

cases in each group. Patients in the control group were given acetaminophen preemptive analgesia before anesthesia induction，while patients in the observation group were given intercostal nerve block on the basis of the control group. The visual analogue scale （VAS） score，Ramsay sedation score，serum β-endorphin level and prostaglandin E2 level 3，12，24 and 48 hours after operation of patients in the two groups were compared. The stress response indexes such as norepinephrine （NE），epinephrine （E） and serum cortisol （Cor），as well as immune function indexes such as CD3

，CD4

and CD4

/CD8

before anesthesia induction and after extubation of patients in the two groups were compared. The incidence of adverse reactions after extubation of patients in the two groups were compared.

Results

The VAS scores of patients after surgery in the two groups gradually increased with time，and the Ramsay sedation scores gradually decreased with time. The VAS scores of patients in the observation group were lower than those in the control group at each postoperative time point，and the Ramsay sedation scores were higher than those in the control group，with statistically significant differences （

0.05）. The levels of serum β-endorphin and prostaglandin E2 of patients after surgery in the two groups gradually decreased with time. The levels of serum β-endorphin of patients at each postoperative time point in the observation group were higher than those in the control group，and the levels of prostaglandin E2 of patients at each postoperative time point in the observation group were lower than those in the control group，with statistically significant differences （

0.05）. The levels of NE，E，and Cor after extubation of patients in the two groups were significantly decreased （

0.05），and those in the observation group were lower than those in the control group （

0.05）. The levels of CD3

，CD4

，and CD4

/CD8

after extubation of patients in the two groups were significantly decreased （

0.05），and those in the observation group were higher than those in the control group （

0.05）. The total incidence of adverse reactions in the observation group was lower than that in the control group，with statistically significant difference （

0.05）.

Conclusion

The application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy has good analgesic and sedative effects on patients，which is helpful to improve patients' immune function and reduce postoperative adverse reactions.

关键词

胸腔镜肺叶切除术对乙酰氨基酚超前镇痛肋间神经阻滞

Keywords

thoracoscopic lobectomyacetaminophenpreemptive analgesiaintercostal nerve block

references

范飒，朱肖萌，康磊.单次竖脊肌平面阻滞+静脉自控镇痛对胸腔镜下肺楔形切除术后的影响［J］.河北医科大学学报，2021，42（12）：1442-1447.doi：10.3969/j.issn.1007-3205.2021.12.016http://dx.doi.org/10.3969/j.issn.1007-3205.2021.12.016.

包义勇，程冰，丁美平.对比分析单次竖脊肌平面阻滞与术中肋间神经阻滞分别联合静脉自控镇痛对胸腔镜肺叶切除患者术后恢复质量的影响［J］.临床和实验医学杂志，2023，22（21）：2350-2353.doi：10.3969/j.issn.1671-4695.2023.21.029http://dx.doi.org/10.3969/j.issn.1671-4695.2023.21.029.

Chou R，Gordon DB，de Leon-Casasola OA，et al.Management of postoperative pain： a clinical practice guideline from the American Pain Society， the American Society of Regional Anesthesia and Pain Medicine， and the American Society of Anesthesiologists' Committee on regional anesthesia， executive committee， and administrative council［J］.J Pain，2016，17（2）：131-157.doi：10.1016/j.jpain. 2015.12.008http://dx.doi.org/10.1016/j.jpain.2015.12.008.

程少毅，陈召，陈静，等.超前镇痛对VATS肺叶切除患者阿片类药物使用的影响［J］.现代生物医学进展，2020，20（5）：885-888.doi：10.13241/j.cnki.pmb.2020.05.018http://dx.doi.org/10.13241/j.cnki.pmb.2020.05.018.

中华医学会肿瘤学分会，中华医学会杂志社.中华医学会肺癌临床诊疗指南（2023版）［J］.中华肿瘤杂志，2023，45（7）：539-574.doi：10.3760/cma.j.cn1121522023051000200-1http://dx.doi.org/10.3760/cma.j.cn1121522023051000200-1.

吕晨，邹建玲，沈淑华，等.视觉模拟量表和语言评价量表用于术后疼痛评估的比较［J］.全科医学临床与教育，2004，2（4）：214-215.doi：10.3969/j.issn.1672-3686.2004.04.006http://dx.doi.org/10.3969/j.issn.1672-3686.2004.04.006.

Ramsay MA，Savage TM，Simpson B，et al.Controlled sedation with alphaxalone-alphadolone［J］.BMJ，1974，2（5920）：656-659.doi：10.1136/bmj.2.5920.656http://dx.doi.org/10.1136/bmj.2.5920.656.

封小红，陶冀.晚期非小细胞肺癌免疫治疗与消融治疗的研究进展［J］.现代肿瘤医学，2021，29（20）：3684-3689.doi：10.3969/j.issn.1672-4992.2021.20.038http://dx.doi.org/10.3969/j.issn.1672-4992.2021.20.038.

夏玉雪，乔远静，李丹丹，等.超前镇痛理念的应用研究进展［J］.护理研究，2022，36（10）：1831-1834.doi：10.12102/j.issn.1009-6493.2022.10.024http://dx.doi.org/10.12102/j.issn.1009-6493.2022.10.024.

程羽静，石海霞，于建设.自控硬膜外镇痛联合对乙酰氨基酚应用在剖宫产术后的镇痛效果［J］.内蒙古医科大学学报，2023，45（2）：149-152.doi：10.16343/j.cnki.issn.2095-512x.2023. 02.013http://dx.doi.org/10.16343/j.cnki.issn.2095-512x.2023.02.013.

姚景余，廖振鹏，陈新野，等.三种药物多模式镇痛在小儿扁桃体和腺样体切除术中的应用［J］.中国新药与临床杂志，2023，42（5）：302-305.doi：10.14109/j.cnki.xyylc.2023.05.07http://dx.doi.org/10.14109/j.cnki.xyylc.2023.05.07.

鲁立军，高双庆，郭圣治，等.超声引导下行肋间神经阻滞镇痛对胸腔镜肺叶切除术后镇痛效果的临床观察［J］.中国实用医药，2021，16（28）：5-8.doi：10.14163/j.cnki.11-5547/r.2021.28.002http://dx.doi.org/10.14163/j.cnki.11-5547/r.2021.28.002.

徐守才，扈智多，陈红，等.不同自控静脉镇痛方案在开胸术后镇痛效果的观察［J］.临床麻醉学杂志，2014（7）：679-681.

龙敏洁，张姣，赵晓娟，等.不同术后镇痛方式对机器人辅助胸外科手术患者的镇痛效果比较［J］.机器人外科学杂志（中英文），2024，5（5）：859-863.doi：10.12180/j.issn.2096-7721. 2024. 05.018http://dx.doi.org/10.12180/j.issn.2096-7721.2024.05.018.

吴玉姣，秦科宇，庄曙明，等.胸腔镜下肺叶切除术对肺癌合并肺结核患者血流动力学、免疫功能和血清炎症因子的影响［J］.抗感染药学，2023，20（10）：1112-1116.doi：10.13493/j.issn.1672-7878.2023.10-0021http://dx.doi.org/10.13493/j.issn.1672-7878.2023.10-0021.

刘婷婷，国擎.地佐辛复合罗哌卡因在胃癌根治术中的效果及对患者E、NE、Cor及认知功能的影响［J］.检验医学与临床，2021，18（9）：1318-1320.doi：10.3969/j.issn.1672-9455.2021.09.038http://dx.doi.org/10.3969/j.issn.1672-9455.2021.09.038

陈晓龙，谈世刚，郭慧，等.地佐辛联合头皮神经阻滞超前镇痛对开颅手术患者镇痛效果及应激反应影响［J］.临床军医杂志，2022，50（4）：368-371.doi：10.16680/j.1671-3826.2022.04.10http://dx.doi.org/10.16680/j.1671-3826.2022.04.10.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy

Observation on the clinical effectiveness of pulsed radiofrequency with intercostal nerve block for postoperative analgesia after elderly thoracoscopic lung surgery

Function analysis of paravertebral nerve block for preemptive analgesia on patients with thoracic surgery

Analgesic effect analysis of preemptive analgesia with oxycodone hydrochloride in abdominal operation

AdipoRon alleviates acetaminopheninduced acute liver injury in mice

Related Author

LI Ji-mei

XIANG Mei

YI Qiang-lin

MO Huai-zhong

SHI Jiao-hui

WANG Tao

XU Xiao-yan

ZHOU Qiao-lin

Related Institution

College of Anesthesiology，Guizhou Medical University

Department of Anesthesiology，Guizhou Provincial People's Hospital

Department of Anesthesiology，Affiliated Hospital of Guizhou Medical University

Department of;Anesthesiology，Affiliated Oncology Hospital of Guizhou Medical University

Department of Anesthesiology，Affiliated Shuyang Hospital of Xuzhou Medical University，Shuyang Jiangsu

⁰