The effect of dexmedetomidine combined with thoracic paravertebral block on sleep quality, serum interleukin -6 and high mobility group protein-1 in patients undergoing thoracoscopic pulmonary surgery / 中国医师进修杂志

ABSTRACT

Objective:To analyze the effect of dexmedetomidine combined with thoracic paravertebral block (TPVB) on sleep quality, serum interleukin-6 (IL-6) and high mobility group protein (HMGB-1) levels in patients undergoing thoracoscopic pulmonary surgery.Methods:The clinical data of 90 patients who received thoracoscopic pulmonary surgery from January 2020 to January 2021 in Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 45 patients were given dexmedetomidine combined with TPVB before operation (experiment group), and 45 patients were given TPVB before operation (control group). The indexes of sleep quality were recorded, including Pittsburgh sleep quality index (PSQI) and total sleep time 24 and 48 h after operation. The visual analogue score (VAS) during quiet and cough 1, 6, 12, 24 and 48 h after operation were recorded. The serum substance P (SP), 5-hydroxytryptamine (5-HT), C-reactive protein (CRP), IL-6 and HMGB-1 before operation and 1 d after operation were detected. The adverse reactions were compared between 2 groups.Results:The PSQI 24 and 48 h after operation in experiment group was significantly lower than that in control group (11.38±4.61) scores vs. (13.65±2.72) scores and (8.78±3.79) scores vs. (10.95±2.81) scores, the total sleep time was significantly longer than that in control group (7.71±2.64) h vs. (5.49±2.10) h and (9.75±3.14) h vs. (7.82±2.67) h, and there were statistical differences ( P<0.01). The VAS during quiet and cough 1, 6 and 12 h after operation in experiment group was significantly lower than that in control group, and there was statistical difference ( P<0.01); there was no statistical difference in the VAS during quiet and cough 24 and 48 h after operation between 2 groups ( P>0.05). There were no statistical differences in serum SP, 5-HT, CRP, IL-6 and HMGB-1 before operation between 2 groups ( P>0.05); the SP, 5-HT, CRP, IL-6 and HMGB-1 1 d after operation in experiment group were significantly lower than those in control group (132.59±10.34) ng/L vs. (141.57±12.26) ng/L, (0.73±0.11) μmol/L vs. (0.95±0.09) μmol/L, (32.46±3.54) mg/L vs. (38.53±4.12) mg/L, (145.67±24.68) ng/L vs. (162.79±23.51) ng/L and (70.35±6.81) ng/L vs. (92.36±7.08) ng/L, and there were statistical differences ( P<0.01). The incidence of adverse reactions in experiment group was significantly lower than that in control group 20.00% (9/45) vs. 48.89% (22/45), and there was statistical difference ( χ2 = 8.32, P = 0.004). Conclusions:Dexmedetomidine combined with TPVB can effectively improve postoperative sleep quality of patients undergoing thoracoscopic pulmonary surgery, relieve pain, and reduce postoperative serum pain mediators and inflammatory factors, with fewer adverse reactions.