背景与目的围术期疼痛质量管理与肿瘤患者的预后相关，优化围术期镇痛方法，进而减轻围术期应激反应，减少阿片类药物用量从而减轻甚至避免由此引起的全身性不良反应和肿瘤标志物水平升高。肺癌患者血清中肿瘤标志物水平与肿瘤发展密切相关，国内外文献未见报道区域阻滞对肺癌肿瘤标志物的影响。本研究评价胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后镇痛效果及外周血肿瘤标志物水平的影响。方法采用随机数字表法将患者分为两组（各20例）：单纯全麻组（G组）和胸椎旁神经阻滞（paravertebral block, PVB）复合全麻组（GP）组。G组采用静脉诱导，静吸复合麻醉维持；GP组诱导前患者清醒时行PVB，PVB效果通过测定阻滞范围来判断，PVB起效后静脉诱导，静吸复合麻醉维持。两组均于术毕缝皮时启动静脉镇痛泵行患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）。分别于术后2 h、24 h和48 h行视觉模拟评分（visual analogue scale, VAS），记录按压次数以及镇痛药用量。分别于术前及术后24 h取两组患者的静脉血样本，检测肿瘤标志物癌胚抗原、糖链抗原199、糖链抗原125、神经元特异性烯醇化酶、细胞角质蛋白19片段的浓度。结果择期行胸腔镜肺癌根治术患者40例，性别不限，年龄20岁-70岁，体重指数（body mass index, BMI）18 kg/m2-25 kg/m2，美国麻醉医师协会（American Society of Anesthesiologists, ASA）分级I级或II级。术后2 h，GP组患者的VAS评分明显低于G组（P=0.013）；术后24 h， GP组患者的VAS评分也明显低于G组（P=0.025）；GP组术后24 h、48 h启动自控按钮次数明显少于G组（P值分别为0.021、0.026）；GP组24 h、48 h PCIA泵的输注总量明显低于G组（P值分别为0.006、0.011）。术后24 h，两组患者肿瘤标志物水平与术前比较变化不大（P>0.05）；比较两组患者肿瘤标志物水平，手术前后的差值差异无统计学意义（P>0.05）。结论胸椎旁神经阻滞可明显减轻胸腔镜肺癌根治术患者术后疼痛并减少静脉镇痛泵内阿片类药物用量；胸椎旁神经阻滞对胸腔镜肺癌根治术患者肿瘤标志物水平无明显影响。%Background and objective Perioperative management of pain associated with the prognosis of cancer patients. Optimization of perio-perative analgesia method, then reduce perioperative stress response, reduce opioiddosage, to reduce or even avoid systemic adverse reactions and elevated levels of tumor markers. Serum levels of tumor markers in patients with lung cancer are closely related to tumor growth. Clinical research reports on regional anesthesia effect on tumor markers for lung cancer are still very little in domesticliterature. hTe aim of this study is to evaluate the effects of thoracic paraverte-bral block on postoperative analgesia and serum level of tumor marker in lung cancer patients undergoing video-assisted thoraco-scopic surgery. Methods Lung cancer patients undergoing video-assisted thoracoscopic surgery were randomly divided into 2 groups (n=20 in each group). hTe patients in group G were given only general anesthesia. hTe thoracic paravertebral blockade (PVB) was performed before general anesthesia in patients of group GP. hTe effect of PVB was judged by testing area of block. Patient controlled intravenous analgesia (PCIA) pump started before the end of surgery in 2 groups. Visual analogue scale (VAS) score was recorded atfer extubation 2 h (T1), 24 h (T2) and 48 h (T3) atfer surgery and the times of PCIA and the volume of analgesic drugs used were recorded during 48 h atfer surgery. hTe serum levels of carcino-embryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), neuron-speciifc enolase (NSE), cytokeratin 19 frag-ment (CYFAR21-1) and squamous cell carcinoma (SCC) in 40 lung cancer cases undergoing video-assisted thoracoscopic lo-bectomy were measured before operation and 24 h atfer operation. Results Forty American Society of Anesthesiologists (ASA) physical status I or II patients, aged 20 yr-70 yr, body mass index (BMI) 18 kg/m2-25 kg/m2, scheduled for elective video-assisted thoraeoscopic lobectomy, VAS scores at T1 and T2 were lower in group GP than those in group G (P=0.013, P=0.025, respectively), PCIA times during postoperative analgesia 24 h and 48 h were lower in group GP than those in group G (P=0.021, P=0.026, respectively), analgesic volume used during postoperative analgesia 24 h and 48 h were lower in group GP than those in group G (P=0.006, P=0.011, respectively). hTe level of tumor marker at post-operative were not signiifcantly decreased than preoperative in both groups (P>0.05). Conclusion Patients in group G feel more painful and a higher dosage of dezocine is required to relieve the pain than group GP. hToracic paravertebralblock has no inlfuence on serum level of tumor marker in lung cancer patients undergoing video-assisted thoraeoscopic lobectomy.
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