肋间神经阻滞联合静脉自控镇痛对老年食管癌患者术后疼痛及早期认知功能的影响  

Effects of intercostal nerve block combined with patient-controlled intravenous analgesia on postoperative pain and early cognitive function of elderly patients with esophageal cancer

作　　者：李印玉 卢传辉 刘伟[1] 

机构地区：[1]河南省周口市中心医院,466000 [2]周口市中医院,466000

出　　处：《中国实用医刊》2017年第6期61-65,共5页Chinese Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目（201004021）

摘　　要：目的观察肋间神经阻滞结合静脉自控镇痛对老年食管癌患者术后疼痛及早期认知功能的影响。方法选择2014年6月至2016年6月拟进行左进胸食管癌根治术的患者60例作为研究对象，将这些患者随机分为试验组与对照组，每组30例。试验组在手术结束前给予肋间神经阻滞联合静脉自控镇痛，对照组仅采用单纯静脉自控镇痛。观察记录两组患者在手术苏醒后1、6、12、24、48h的血压、心率、脉搏氧饱和度（SpO2）、用力肺活量（FVC）、静息以及运动时的视觉模拟评分（VAS评分）、BCS舒适评分、镇痛泵有效按压次数以及患者术后认知功能障碍（POCD）的发生率。结果术后1h试验组患者的血压及心率均显著低于对照组（P〈0．05）；术后试验组患者各个时间点的用力肺活量（FVC）均显著高于同时间点的对照组（P〈0．05）；试验组苏醒后6、12、24、48hBCS评分及术后3、5、7dMMSE评分均显著高于对照组（P〈0．05）；试验组术后各时间点静止与运动时VAS评分均显著低于对照组（P〈0．05）；两组患者术后血氧饱和度比较差异未见统计学意义（P〉0．05）；试验组术后3、5、7dPOCD的发生率均低于对照组，但差异未见统计学意义（P〉0．05）。结论肋间神经阻滞结合静脉自控镇痛能够有效缓解老年食管癌患者术后疼痛，提高患者术后的舒适度，降低患者术后认知功能障碍的发生率，有利于患者术后康复。Objective controlled intravenous analgesia esophageal To observe the effects of intercostal nerve block combined with patienton postoperative pain and early cognitive function of elderly patients with cancer. Methods From June 2014 to June 2016, 60 patients with esophageal cancer were collected, they were randomly divided into two groups, with 30 cases in each group. The observation group received intercostal nerve block combined with intravenous analgesia, and the control group received patient-controlled intravenous analgesia. The blood pressure, heart rate, SpO2, FVC VAS score, BCS comfort score and effective pressing times of postoperative analgesia pump 1, 6, 12, 24, 48 hours after surgery were observed ; the MMSE scores were observed 1 day before surgery and 3, 5, 7 days after surgery. Results Compared with the control group, the blood pressure, heart rate of observation group at 1 hour after operation was significantly lower （ P 〈 0. 05 ）, and the FVC score of observation group at postoperative 1, 6, 12, 24, 48 hours were significantly higher （P 〈 0. 05 ）. The rest and exercise VAS scores of observation group at postoperative 1, 6, 12, 24, 48 hours were significantly lower （P 〈0. 05）, and the BCS scores of observation group at 6, 12, significantly higher （ P 〈 0. 05 ）. The MMSE scores of observation 24, 48 hours after operation were group at postoperative 3, 5, 7 days were significantly higher （P 〈 0. 05 ）, and the incidence of POCD in observation group postoperative 3, 5, 7 days were significantly higher than those in control group. Conclusions Intercostal nerve block combined with atient-controlled intravenous analgesia can relieve postoperative pain, reduce the incidence of POCD, improve the postoperative patient comfort and help the postoperative patient recovery rapidly.

关 键 词：肋间神经阻滞 静脉自控镇痛 老年食管癌患者 术后认知功能 

分 类 号：R614[医药卫生—麻醉学]