超声引导下连续椎旁神经阻滞在老年食管癌术后镇痛中的应用价值  

Application value of ultrasound-guided continuous paravertebral nerveblock for postoperative analgesia in the elderly with esophageal cancer

作　　者：燕丽丽[1] 薛春竹[1] 何菊芳[1] 王欢[1] 李静辉[1] YAN Lili;XUE Chunzhu;HE Jufang;WANG Huan;LI Jinghui(Department of Cardiothoracic Surgery,Guangyuan First People’s Hospital,Sichuan 628017,China)

机构地区：[1]四川省广元市第一人民医院心胸外科,628017

出　　处：《临床超声医学杂志》2021年第4期292-295,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声引导下连续椎旁神经阻滞(PVNB)对老年食管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身麻醉下开胸手术的90例老年食管癌患者为研究对象,其中45例术前行超声引导下PVNB麻醉复合全身麻醉(PVNB组),45例采用单纯全身麻醉(对照组)。两组患者术后均采用静脉自控镇痛,比较术后2 h、6 h、24 h及48 h在静息和咳嗽状态下的视觉模拟疼痛评分(VAS)、镇痛药物用量、药物不良反应发生情况,以及术前和术后24 h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)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)等指标的差异及术后肺部感染发生情况。结果PVNB组术后2 h、6 h及12 h静息状态和咳嗽状态下VAS评分均低于对照组,术后镇痛泵按压次数、芬太尼用量均低于对照组,差异均有统计学意义(均P<0.05)。两组术前血清NE、E、Cor、IL-6、IL-10、TNF-α比较差异均无统计学意义;PVNB组术后24 h血清NE、E、Cor、IL-6、TNF-α均低于对照组,差异均有统计学意义(均P<0.05);IL-10稍高于对照组,但差异无统计学意义。PVNB组和对照组术后发生肺部感染分别为2例和6例,差异有统计学意义(4.4%vs.13.3%,P<0.05)。结论超声引导下PVNB能够改善老年食道癌开胸手术患者术后镇痛效果,减轻手术创伤所致的应激反应,减少术后肺部感染的发生。Objective To explore the effects of ultrasound-guided continuous paravertebral nerve block(PVNB)on displacement analgesia,stress and inflammatory factors in elderly patients undergoing thoracotomy for esophageal cancer.Methods Ninety patients with esophageal cancer underwent thoracotomy under general anesthesia in our hospital were selected.Among them,45 patients underwent preoperative ultrasound-guided PVNB anesthesia combined with general anesthesia(PVNB group),and the rest 45 patients received general anesthesia(control group).Patients of both groups were treated with intravenous patient-controlled analgesia after surgery.The visual analogue pain score(VAS)during the resting state and cough state at 2 h,6 h,24 h and 48 h after surgery,the dosage of analgesic drugs and the occurrence of adverse drug reactions were compared between the two groups.The level of NE,E,Cor,IL-6,IL-10,TNF-αin serum before and 24 h after surgery,and the occurrence of postoperative lung infections were compared between the two groups.Results The VAS of the PVNB group was significantly lower than that of the control group in the resting state and cough state at 2 h,6 h,and 12 h after the operation(all P<0.05).The usage of postoperative analgesic pump and the amount of sufentanil were significantly lower than those of the control group(both P<0.05).There were no significant difference in the level of NE,E,Cor,IL-6,IL-10,and TNF-αin serum between the two groups before surgery.The levels of NE,E,Cor,IL-6,and TNF-αin serum of PVNB group were significantly lower than those of control group 24 h after surgery(P<0.05).The level of IL-10 of PVNB group was higher than that of the control group,but there was no significant difference.Two cases of pulmonary infections were found in the PVNB group,6 cases in the control group,and the difference between the two groups was statistically significant(4.4%vs.13.3%,P<0.05).Conclusion Ultrasound-guided PVNB can improve postoperative analgesia,reduce the stress response caused by surgical trauma,and redu

关 键 词：超声引导 连续椎旁神经阻滞 食管癌 开胸手术 镇痛 应激反应 炎症因子 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.1[医药卫生—诊断学]