微创医学

目的探讨术后埋针联合右美托咪定麻醉诱导下肋间神经阻滞对经胸腔镜根治术后肺癌患者疼痛应激及早期恢复质量的影响。方法选取120例行胸腔镜根治术的肺癌患者，根据随机数字表法将患者分成对照组和观察组，每组60例，给予对照组右美托咪定麻醉诱导下肋间神经阻滞，观察组在对照组基础上进行术后埋针。比较两组患者不同时间点的疼痛视觉模拟评分法（VAS）、应激指标（血清皮质醇、肾上腺素、白细胞介素-6水平）、术后恢复质量（术后首次下床时间、住院时长、胸管拔除时间）。结果两组患者术后疼痛VAS评分有随时间变化的趋势（P<0.05），术后24 h两组患者疼痛VAS评分较术后12 h降低，且观察组低于对照组；术后48 h两组患者疼痛VAS评分较术后12 h、24 h降低，且观察组低于对照组（P<0.05）。观察组术后24 h血清皮质醇、肾上腺素、白细胞介素-6水平低于对照组（P<0.05），术后首次下床时间、住院时长、胸管拔除时间短于对照组（P<0.05）。结论术后埋针联合右美托咪定麻醉诱导下肋间神经阻滞可有效减轻经胸腔镜根治术后肺癌患者疼痛，抑制应激反应，加速康复进程。

Objective To explore the effect of postoperative needle-embedding combined with intercostal nerve block under dexmedetomidine anesthetic induction on postoperative pain stress and early recovery quality in patients with lung cancer after video-assisted thoracoscopic radical surgery. Methods A total of 120 patients with lung cancer undergoing video-assisted thoracoscopic radical surgery were selected and divided into a control group and an observation group by using the random number table method, with 60 cases in each group. The control group was given intercostal nerve block under dexmedetomidine anesthetic induction, while the observation group received postoperative needle-embedding on the basis of the intervention in the control group. The two groups of patients were compared in terms of the Visual Analogue Scale (VAS) pain scores, stress indicators (serum cortisol, epinephrine, and interleukin-6 levels), and postoperative recovery quality (time to first ambulation, length of hospital stay, and time to chest tube removal after surgery) at different time points. Results In both groups, the postoperative VAS pain scores showed a time-dependent trend (P<0.05). At 24 hours postoperatively, the VAS scores in both groups were lower than those at 12 hours postoperatively, with the observation group having lower scores than the control group; at 48 hours postoperatively, the VAS scores in both groups were lower compared with those at 12 hours and 24 hours postoperatively, and the scores in the observation group were still lower than those in the control group (P<0.05). Additionally, the levels of serum cortisol, epinephrine, and interleukin-6 at 24 hours postoperatively, as well as the time to first ambulation, length of hospital stay, and time to chest tube removal after surgery, were all lower/shorter in the observation group than in the control group (P<0.05). Conclusion Postoperative needle-embedding combined with intercostal nerve block under dexmedetomidine anesthetic induction can effectively alleviate pain, inhibit stress response, and accelerate the rehabilitation process in patients with lung cancer after video-assisted thoracoscopic radical surgery.