分析胸腔内迷走神经阻滞复合全身麻醉在胸腔镜肺癌肺叶切除术中的安全性和有效性。

收集2020年4月至2024年3月我院行胸腔镜肺叶切除术的原发性肺癌患者95例，依据麻醉方法不同分为对照组52例和观察组43例。对照组给予全身麻醉，观察组术中在胸腔镜下行气管下段右侧迷走神经阻滞复合全麻，予0.75%罗哌卡因2.5 ml。比较两组血流动力学、肺功能指标、肺部CT影像学、术后疼痛强度、术后康复情况、术后恶心呕吐、头晕等不良反应发生情况。

手术开始后30 min、手术开始后60 min时，两组患者心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)水平低于麻醉诱导前，观察组HR、MAP水平低于对照组(P<0.05)。单肺通气40 min时，观察组气道峰压(peak airway pressure, Ppeak)(21.02±2.87)cmH₂O、气道平台压(plateau airway pressure, Pplat)水平(20.74±2.79)cmH₂O低于对照组(22.61±2.96)cmH₂O、(22.18±3.01)cmH₂O，而肺动态顺应性(dynamic lung compliance, Cdyn)水平(29.11±5.17)ml/cmH₂O高于对照组(27.03±4.59)ml/cmH₂O(P<0.05)。肺部CT影像学结果显示，观察组肺炎2例、肺不张1例、胸腔积液1例；对照组肺炎1例、肺不张2例，两组间比较无统计学意义(P>0.05)。术后6 h、12 h、24 h时，观察组视觉模拟疼痛评分(2.24±0.67)分、(3.61±0.94)分、(2.47±0.84)分低于对照组(2.63±0.81)分、(4.23±1.16)分、(3.06±0.63)分(P<0.05)；术后2 d，观察组康复质量评分量表(quality of recovery-15 scale，QoR-15)评分(151.34±6.25)分高于对照组(148.13±7.76)分(P<0.05)。观察组发生术后不良13例(30.23%)低于对照组24例(46.15%)(P>0.05)。

胸腔内迷走神经阻滞复合全身麻醉应用于胸腔镜肺叶切除术具有临床意义，能够保证术中通气效率和血流动力学稳定，患者术后镇痛、康复效果和安全性好。

To analyze the safety and effectiveness of intrathoracic vagus nerve block combined with general anesthesia in thoracoscopic lobectomy for lung cancer.

A total of 95 patients with primary lung cancer who underwent thoracoscopic lobectomy at Qianjiang Central Hospital from April 2020 to March 2024 were collected. According to different anesthesia methods, they were divided into a control group with 52 cases and a observation group with 43 cases. The control group was given general anesthesia. The observation group received vagus nerve block on the right side of the lower segment of the trachea under thoracoscopy combined with general anesthesia, and was administered 2.5 ml of 0.75% ropivacaine. Compared the hemodynamics, pulmonary function indicators, pulmonary CT imaging, postoperative pain intensity, postoperative rehabilitation status, and the occurrence of adverse reactions such as postoperative nausea, vomiting, dizziness, etc, between the two groups.

At thirty minutes and sixty minutes after the start of the operation, the heart rate (HR) and mean arterial pressure (MAP) levels of the patients in both groups were significantly lower than those before anesthesia induction, and the HR and MAP levels in the observation group were significantly lower than those in the control group (P<0.05). At forty minutes of one-lung ventilation, the peak airway pressure (Ppeak) and plateau airway pressure (Pplat) levels in the observation group [(21.02±2.87) cmH₂O, (20.74±2.79) cmH₂O] were significantly lower than those in the control group [(22.61±2.96) cmH₂O, (22.18±3.01) cmH₂O], while the dynamic lung compliance (Cdyn) level [(29.11±5.17) ml/cmH₂O] was significantly higher than that in the control group [(27.03±4.59) ml/cmH₂O] (P<0.05). The results of pulmonary CT imaging: There were 3 cases of pneumonia in the control group and 2 cases in the observation group after the operation, 1 case of atelectasis in the control group and 1 case in the observation group, 2 cases of pleural effusion in the control group and 1 case in the observation group, and the rest were normal. There was no significant difference between the two groups (P>0.05). At 6 hours, 12 hours, and 24 hours after the operation, the visual analogue pain scale scores in the observation group [(2.24±0.67) points, (3.61±0.94) points, (2.47±0.84) points] were significantly lower than those in the control group (2.63±0.81) points, (4.23±1.16) points, (3.06±0.63) points (P<0.05). At 2 days after the operation, the score of the quality of recovery-15 scale (QoR-15) in the observation group (151.34±6.25) points was higher than that in the control group (148.13±7.76) points (P<0.05). The observation group reported 13 postoperative adverse events (30.23%) lower than control group 24 cases (46.15%), there was no significant difference in the incidence of postoperative adverse reactions between the two groups (P>0.05).

Intrathoracic vagus nerve block combined with general anesthesia is feasible for thoracoscopic lobectomy. It can not only ensure the intraoperative ventilation efficiency and hemodynamic stability, but also provide good postoperative analgesia, rehabilitation effects, and safety for patients.