南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (10): 1526-1531.doi: 10.12122/j.issn.1673-4254.2022.10.12

• • 上一篇    下一篇

胸椎旁阻滞可改善肺癌切除术患者的预后

麦冬梅，饶 艳，陈东泰，李 强，何 雯，曾维安，邢 蔚   

  1. 中山大学肿瘤防治中心//华南肿瘤学国家重点实验室//肿瘤医学协同创新中心麻醉科，广东 广州 510060
  • 出版日期:2022-10-20 发布日期:2022-10-31

Thoracic paravertebral block improves the prognosis of patients undergoing lung cancer surgery

MAI Dongmei, RAO Yan, CHEN Dongtai, LI Qiang, HE Wen, ZENG WeiAn, XING Wei   

  1. Department of Anesthesiology, Sun Yat- sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
  • Online:2022-10-20 Published:2022-10-31

RichHTML

52

PDF

322

摘要： 目的 探索胸椎旁阻滞（TPVB）对肺癌切除术患者预后的影响。方法 选取本中心2017年1月~2018年5月接受单纯全身麻醉（GA）或全身麻醉联合TPVB（TPVB+GA）下肺癌切除术的初治肺癌患者，并通过对基线特征行倾向性评分匹配，最终以1∶2分别纳入47例TPVB+GA行肺癌切除术的患者和94例GA行肺癌切除术的患者进行回顾性分析，比较胸椎旁阻滞对肺癌切除术患者5年总生存时间（OS）、无复发生存时间（PFS）、术中阿片类药物用量等的影响。结果 生存分析显示TPVB+GA组患者PFS较GA组显著延长（log-rank P=0.034），其中TPVB+GA组优势比OR 0.45（95%CI，0.33~0.89）；进一步对各临床参数作单因素与多因素Cox回归分析，再次验证了上述结果，TPVB 是肺癌手术患者的独立预后因素（P=0.002，OR=0.33，95%CI，0.16~0.66）。Cox回归生存分析还发现术中瑞芬太尼使用剂量较低与肺癌患者预后较好有显著相关（P=0.017，OR=0.47，95%CI，0.25~0.87），卡方检验则表明TPVB明显降低术中瑞芬太尼剂量。结论 胸椎旁阻滞可延长肺癌切除术患者无复发生存时间，改善预后。

关键词: 胸椎旁阻滞；肺癌切除术；预后

Abstract: Objective To explore the effect of thoracic paravertebral anesthesia (TPVB) on prognosis of patients undergoing resection of lung cancer. Methods This study was conducted among the patients undergoing surgical resection of primary lung cancer under general anesthesia or TPVB combined with general anesthesia (TPVB+GA) between January, 2017 and May, 2018. The patients were enrolled in TPVB+GA group and GA group (control group) using a propensity score matching (PSM) method at the ratio of 1∶2 based on their baseline characteristics. The clinical parameters, 5-year overall survival (OS), progression-free survival (PFS) and intraoperative dosage of opioids were compared between the two groups to assess the impact of TPVB on prognosis of the patients. Results Forty- seven patients were enrolled in TPVB+GA group and 94 in the control group. Kaplan-Meier survival analysis showed a significantly prolonged PFS in the patients with TPVB+GA (log-rank P=0.034), with an odds ratio (OR) of 0.45 (95% CI: 0.33-0.89). Consistently, univariate and multivariate Cox regression analyses identified TPVB as an independent protective prognostic factor for patients with lung cancer resection (P=0.002, OR=0.33, 95%CI: 0.16-0.66). Cox regression analyses indicated that a lower intraoperative dose of remifentanil was significantly correlated with a longer PFS of the patients following lung cancer resection (P=0.017, OR=0.47, 95% CI: 0.25- 0.87). Chi- square test confirmed that TPVB, but not general anesthesia, significantly reduced intraoperative dose of remifentanil, indicating a possible synergistic effect of TPVB with opioids to affect the survival of the patients. Conclusion TPVB can prolong the survival time and improve the prognosis of the patients undergoing surgical resection of lung cancer.

Key words: thoracic paravertebral block; lung cancer surgery; prognosis