地塞米松联合罗哌卡因行肋间神经阻滞作用于单孔胸腔镜下肺癌根治术后的镇痛效果分析
Analysis of the Analgesic Effect of Dexamethasone Combined with Ropivacaine on Intercostal Nerve Block after Single-Port Thoracoscopic Radical Resection of Lung Cancer

众所周知，电视辅助胸腔镜手术(Video-assisted thoracoscopic surgery, VATS)比传统的开胸手术创伤性更小，术后疼痛更少，对术后呼吸道影响更小，住院时间更短，患者依从性更高，手术成本更低，近年来电视辅助胸腔镜手术(VATS)也被用于更复杂的手术方式，如肺叶切除术、肺段切除术、袖状成形术。相比较传统开胸手术而言，单孔电视胸腔镜手术只需要较小的手术操作口，对胸壁组织损伤更小，但由于手术可造成肋间肌肉的断裂、胸壁相应的肋间神经损伤，术后需留置胸腔引流管，术后疼痛是影响胸外科患者术后康复最为重要的因素之一，手术治疗后常常因疼痛导致拒绝咳嗽、咳痰从而引发肺不张及肺部感染。在普胸外科术后会产生剧烈的疼痛，手术治疗后相关疼痛的术后管理就显得格外重要，否则会影响患者的加速康复理念。为了控制单孔电视辅助胸腔镜手术(VATS)术后疼痛有多种镇痛方式，各家医院采用不同方式治疗患者术后疼痛。其中因为操作简单、方便使用而引发广泛使用的肋间神经阻滞受到临床医生的青睐。常用的肋间神经阻滞药物有布比卡因、利多卡因、罗哌卡因等，但良好的局麻药物应该起效时间短、维持时间长、副作用小，本文主要分析地塞米松联合罗哌卡因肋间神经阻滞在视频辅助胸腔镜下肺叶切除术手术快速康复中的镇痛效果。
As we all know, video-assisted thoracoscopic surgery (VATS) is less traumatic than traditional thoracoscopic surgery, with less postoperative pain, less impact on the postoperative airway, shorter hospital stay, and higher patient compliance. The cost is lower. In recent years, video-assisted thoracoscopic surgery (VATS) has also been used for more complex surgical methods, such as lobectomy, segmentectomy, and sleeve plasty. Compared with traditional open thoracic surgery, single-port video-assisted thoracoscopic surgery requires only a smaller surgical port and less damage to the chest wall tissue. However, because the operation can cause the rupture of the intercostal muscles and the corresponding intercostal nerve damage in the chest wall, thoracic drainage tube needs to be indwelled after operation. Postoperative pain is one of the most important factors affecting the recovery of thoracic surgery patients. After surgical treatment, pain often leads to refusal to cough and expectoration, which leads to atelectasis and lung infection. Severe pain will occur after general thoracic surgery, and postoperative management of related pain after surgical treatment is extremely important, otherwise it will affect the patient’s concept of accelerated recovery. In order to control the postoperative pain of single-port video assisted thoracoscopic surgery (VATS), there are many analgesic methods, and various hospitals adopt different methods to treat patients’ postoperative pain. Among them, intercostal nerve block, which is widely used because of its simple operation and convenient use, is favored by clinicians. Commonly used intercostal nerve block drugs include bupivacaine, lidocaine, ropivacaine, etc., but a good local anesthetic drug should have an onset time period, a long maintenance time, and small side effects. This article mainly analyzes the analgesic effect of dexamethasone combined ropivacaine intercostal nerve block in the rapid recovery of video-assisted thoracoscopic lobectomy surgery.