胸椎旁阻滞在老年胸科手术患者中应用对术后不良结局的影响。
Impact of paravertebral blockade use in geriatric patients undergoing thoracic surgery on postoperative adverse outcomes.
作者信息
Tong Chaoyang, Zhu Hongwei, Li Bin, Wu Jingxiang, Xu Meiying
机构信息
Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
出版信息
J Thorac Dis. 2019 Dec;11(12):5169-5176. doi: 10.21037/jtd.2019.12.13.
BACKGROUND
While it is known that thoracic paravertebral blockade (TPVB) could reduce pain undergoing thoracic surgery, it has not been confirmed whether this reduction in pain reduces pulmonary complications in an elderly population.
METHODS
We performed a monocentric retrospective analysis for a prospectively collected patients receiving thoracic surgery with or without intraoperative TPVB between November 7, 2018 and April 1, 2019, at Shanghai Chest Hospital. Whether or not to use TPVB depending on anesthesiologists' preference, the chances of harm and benefit of each patients after discussed with their anesthetist. Chest wall resection, bilateral lung resection, conversion to thoracotomy and ipsilateral reoperation were excluded. A total of 154 patients with lung operations were included in the final analysis, 34 of whom received general anesthesia combined with TPVB (GA-TPVB). The primary outcome was the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were the incidence of cardiovascular and other complications, required analgesia in post anesthesia care unit (PACU), patient controlled analgesia (PCA) pressing frequency in 24h, chest tube duration, ICU stay and the hospital length of stay (LOS).
RESULTS
The incidence of PPCs undergoing thoracic surgery was about 21.4% (33/154). Compared with GA, GA-TPVB could reduce the incidence of PPCs (25% 9%, P=0.042), mostly reduce postoperative atelectasis (19% 3%, P=0.021). TPVB could reduce the rate of required analgesia in PACU, PCA pressing frequency in 24 h and chest tube duration. However, there were no significant differences on the rate of cardiovascular and other complications, ICU stay and LOS between the two groups (P>0.05). Multivariable logistic regression analysis identified preoperative DLCO% ≥92% (OR =0.293, P=0.006), duration of surgery <75 min (OR =0.278, P=0.008) and GA-TPVB (OR =0.270, P=0.048) was associated with fewer PPCs.
CONCLUSIONS
Our study shows that general anesthesia combined with TPVB may reduce PPCs by reducing postoperative pain in geriatric patients undergoing thoracic surgery compared with general anesthesia alone.
TRIAL REGISTRATION
Chinese Clinical Trial Registry number, ChiCTR1800019526. Registered on Nov 7, 2018.
背景
虽然已知胸椎旁神经阻滞（TPVB）可减轻胸科手术中的疼痛，但在老年人群中，这种疼痛减轻是否能减少肺部并发症尚未得到证实。
方法
我们对2018年11月7日至2019年4月1日在上海胸科医院接受胸科手术且术中接受或未接受TPVB的前瞻性收集患者进行了单中心回顾性分析。是否使用TPVB取决于麻醉医生的偏好，每位患者在与麻醉医生讨论后了解各自的风险和益处。排除胸壁切除术、双侧肺切除术、转为开胸手术和同侧再次手术的患者。最终分析纳入了154例肺部手术患者，其中34例接受全身麻醉联合TPVB（GA-TPVB）。主要结局是术后肺部并发症（PPCs）的发生率。次要结局包括心血管和其他并发症的发生率、麻醉后监护病房（PACU）所需的镇痛、术后24小时患者自控镇痛（PCA）按压频率、胸管留置时间、重症监护病房（ICU）住院时间和住院时长（LOS）。
结果
胸科手术患者中PPCs的发生率约为21.4%（33/154）。与单纯全身麻醉（GA）相比，GA-TPVB可降低PPCs的发生率（25%对9%，P=0.042），主要减少术后肺不张（19%对3%，P=0.021）。TPVB可降低PACU所需镇痛率、术后24小时PCA按压频率和胸管留置时间。然而，两组在心血管和其他并发症发生率、ICU住院时间和住院时长方面无显著差异（P>0.05）。多变量逻辑回归分析确定术前一氧化碳弥散量（DLCO）%≥92%（比值比[OR]=0.293，P=0.006）、手术时长<75分钟（OR=0.278，P=0.008）和GA-TPVB（OR=0.270，P=0.048）与较少的PPCs相关。
结论
我们的研究表明，与单纯全身麻醉相比，全身麻醉联合TPVB可能通过减轻老年胸科手术患者的术后疼痛来减少PPCs。
试验注册
中国临床试验注册中心编号，ChiCTR1800019526。于2018年11月7日注册。
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