| 摘要: |
| 目的 探讨超声引导下连续椎旁神经阻滞(PVNB)对老年食道癌开胸手术患者术后镇痛、应激及炎性因子水平的影响。方法 选取我院拟实施全麻下开胸手术的90例食道癌开胸手术患者作为研究对象,其中45例患者术前采用超声引导下PVNB麻醉复合全身麻醉(PVNB组)、对照组45例患者采用全身麻醉；两组患者术后均采用静脉自控镇痛(对照组)；对比两组患者术后2h、6h、24h及48h静息状态、咳嗽状态下的视觉模拟疼痛评分(VAS),术后镇痛药物用量及镇痛药物不良反应发生情况,术前及术后24h血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)差异及术后肺部感染发生情况。结果 PVNB组患者和对照组在术后2h～术后48h的静息VAS评分及咳嗽VAS评分组间比较,差异具有统计学意义(P<0.05),PVNB组术后2h、6h及24h静息VAS评分及咳嗽VAS评分均高于对照组(P>0.05)。PVNB组患者术后的镇痛泵按压次数、舒芬太尼用量均低于对照组(P<0.05),PVNB组患者术后的镇痛泵按压次数、舒芬太尼用量均低于对照组(P<0.05),术前两组患者的血清NE、E、Cor水平差异无统计学意义(P>0.05)；术后两24h两组患者血清NE、E、Cor水平均较术前增高(P>0.05),术后24h PVNB组的血清NE、E、Cor水平低于对照组(P<0.05),术前两组患者的血清IL-6、TNF-α水平差异无统计学意义(P>0.05)；术后24h两组患者血清IL-6、IL-10、TNF-α水平均较术前增高(P<0.05),PVNB组的血清IL-6、TNF-α水平低于对照组(P<0.05),PVNB组术后发生肺部感染2例,发生率为4.4%,对照组术后发生肺部感染6例,发生率为13.3%,PVNB组术后肺部感染发生率低于对照组(P<0.05)。结论 超声引导下PVNB能够改善老年食道癌开胸患者术后镇痛效果,减轻手术创伤所致的应激反应,较少患者术后肺部感染的发生。 |
| 关键词: 连续椎旁神经阻滞 食道癌 开胸手术 镇痛 应激反应 炎症因子 |
| DOI： |
| 投稿时间：2020-03-05修订日期：2021-03-07 |
| 基金项目: |
|
| Effect of ultrasound-guided PVNB on postoperative analgesia, stress and inflammatory factors in elderly patients with esophageal cancer undergoing thoracotomy |
| Yan Lili |
| (Department of Cardiothoracic Surgery,Guangyuan First People''''s Hospital,Guangyuan,Sichuan,628017) |
| Abstract: |
| Objective To investigate the effect of ultrasound-guided continuous paravertebral nerve block (PVNB) on postoperative analgesia, stress and inflammatory factors in elderly patients with esophageal cancer undergoing thoracotomy. Methods 90 patients with oesophagus cancer undergoing thoracotomy under general anesthesia were selected as the subjects of study. 45 patients were given PVNB anesthesia combined with general anesthesia (PVNB group) and 45 patients in the control group before operation under the guidance of ultrasound. Patients in the two groups were given intravenous self controlled analgesia (control group) after operation. Patients in the two groups were compared in resting state at 2h, 6h, 24h and 48h after operation The visual analogue pain score (VAS) in the state of coughing and coughing, the dosage of analgesics and adverse reactions of analgesics after operation, the differences of NE, e, cor, IL-6, TNF - α in serum before and 24 hours after operation, and the occurrence of pulmonary infection after operation. Results there were significant differences between the two groups (P < 0.05), and the two groups (P > 0.05). In PVNB group, the number of postoperative analgesia pump press and sufentanil dosage were lower than those in the control group (P < 0.05), while in PVNB group, the number of postoperative analgesia pump press and sufentanil dosage were lower than those in the control group (P < 0.05). There was no statistical significance between the two groups in serum ne, e and cor levels (P > 0.05); the serum ne, e and cor levels in the two groups were higher than those before operation (P > 0.05) The serum levels of NE, e and cor in PVNB group were lower than those in the control group (P < 0.05) 24 hours after operation, and there was no significant difference in the serum levels of IL-6 and TNF - α between the two groups before operation (P > 0.05); the serum levels of IL-6, IL-10 and TNF - α in PVNB group were higher than those before operation (P < 0.05), the serum levels of IL-6 and TNF - α in PVNB group were lower than those in the control group (P < 0.05), and the postoperative pulmonary infection in PVNB group was 2 The incidence of pulmonary infection in PVNB group was lower than that in control group (P < 0.05). Conclusion ultrasound-guided PVNB can improve the postoperative analgesia effect of elderly patients with esophageal cancer, reduce the stress response caused by surgical trauma, and reduce the incidence of postoperative pulmonary infection. |
| Key words: continuous paravertebral nerve block esophageal cancer thoracotomy analgesia stress response inflammatory factors |
