布比卡因脂质体胸椎旁神经阻滞对胸腔镜肺叶切除术患者术后镇痛及炎症反应的影响OA
Effect of liposomal bupivacaine thoracic paravertebral block on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic lobectomy
目的 探讨布比卡因脂质体胸椎旁神经阻滞(TPVB)对胸腔镜肺叶切除术患者术后镇痛及炎症反应的影响.方法 选择2025年10月至2026年2月在新疆医科大学第一附属医院择期行胸腔镜肺叶切除术患者96例,性别不限,年龄18～75岁,美国麻醉医师协会分级Ⅱ或Ⅲ级,体质量指数18～32 kg/m2,采用随机数字表法将患者分为布比卡因脂质体组(BL 组,n=48)和盐酸罗哌卡因组(RH 组,n=48).麻醉诱导前30 min 行超声引导下TPVB,BL 组注射20mL含0.665％布比卡因脂质体的混悬液,RH 组注射20mL含0.375％罗哌卡因的混合溶液.记录术后24、48、72h时恢复质量-15量表(QoR-15)评分,术后6、24h两组患者血清白细胞介素(IL-6)水平,术后 24、72h两组患者 C 反应蛋白(CRP)水平,术后 12、24h两组患者 Clara 细胞分泌蛋白(CC16)水平,患者术后6、12、24、48、72 h静息和活动时的视觉模拟评分(VAS),术后患者首次按压镇痛泵时间和术后72 h内阿片类药物用量.结果 与RH组比较,BL组术后24、48、72 h的QoR-15评分显著升高[(118.5±8.2)vs(109.2±7.6),(129.8±7.5)vs(117.3±8.1),(135.2±6.8)vs(124.5±7.2),P<0.05];术后 6、24 h 的 IL-6、术后 24、72 h的CRP及术后12、24 h的CC16水平均显著降低(P<0.05);首次按压镇痛泵时间延长(14.0 h vs 7.5 h,P<0.05),术后 72 h 内阿片类药物用量减少[(11.6±4.2)mg vs(19.8±5.1)mg,P<0.05],恶心呕吐发生率降低(12.5％vs 20.8％,P<0.05).结论 布比卡因脂质体TPVB 可提高胸腔镜肺切除术患者术后恢复质量.
Objective To investigate the effect of liposomal bupivacaine thoracic paravertebral block(TPVB)on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic lobectomy.Methods A total of 96 patients of both sexes,aged 18-75 years,of American Society of Anesthesiologists physical statusⅡ or Ⅲ,with body mass index 18-32 kg/m²,scheduled for elective thoracoscopic lobectomy at the First Affiliated Hospital of Xinjiang Medical University from October 2025 to February 2026 were enrolled and randomly divided into liposomal bupivacaine group(group BL,n=48)and ropivacaine hydrochloride group(group RH,n=48)using the random number table method.Ultrasound guided TPVB was performed 30 min before anesthesia induction.Group BL received 20 mL of 0.665%liposomal bupivacaine suspension,and group RH received 20 mL of 0.375%ropivacaine solution.The following parameters were recorded:Quality of Recovery15(QoR-15)scores at 24,48 and 72 h postoperatively;serum interleukin6(IL-6)levels at 6,24 h postoperatively;creactive protein(CRP)levels at 24,72 h postoperatively;Clara cell secretory protein(CC16)levels at 12,24 h postoperatively.Secondary outcomes included visual analogue scale(VAS)scores at rest and during activity at 6,12,24,48 and 72 h postoperatively,time to first patientcontrolled analgesia(PCA)bolus,and opioid consumption within 72 h postoperatively.Results Compared with group RH,group BL had significantly higher QoR-15 scores at 24,48 and 72 h postoperatively[(118.5±8.2)vs.(109.2±7.6),(129.8±7.5)vs.(117.3±8.1),(135.2±6.8)vs.(124.5±7.2),all P＜0.05];significantly lower levels of IL6 at 6 h and 24 h,CRP at 24 h and 72 h,and CC16 at 12 h and 24 h(all P＜0.05);prolonged time to first PCA bolus[14.0 h vs.7.5 h,P＜0.05];reduced opioid consumption within 72 h[(11.6±4.2)mg vs.(19.8±5.1)mg,P＜0.05];and lower incidence of nausea and vomiting(12.5%vs.20.8%,P＜0.05).Conclusion Liposomal bupivacaine TPVB improves the quality of recovery in patients undergoing thoracoscopic lobectomy.
张轩;吐逊阿依·马拉洪;李雪燕;程逍;吴建江;程虎
新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054新疆医科大学第一附属医院麻醉科,新疆围术期器官保护重点实验室,乌鲁木齐 830054
布比卡因脂质体胸椎旁神经阻滞胸腔镜肺切除术早期恢复质量
liposomal bupivacainethoracic paravertebral blockthoracoscopylobectomyearly recovery quality
《麻醉安全与质控》 2026 (4)
330-334,5
国家卫生健康委慢病管理研究项目(GWJJMB202510021111)新疆维吾尔自治区天山创新团队项目(2025D14008)
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