持续静脉镇痛对食管癌手术患者苏醒质量及早期认知功能的影响研究  

Effect of continuous intravenous analgesia on recovery quality and early cognitive function in patients with esophageal cancer

作　　者：丁亚军[1] 赵亚飞 宋荣燕 张雷 陈小红[1] 陈海涛[1] 曹汉忠[1] 钱燕宁[3] DING Yajun;ZHAO Yafei;SONG Rongyan;ZHANG Lei;CHEN Xiaohong;CHEN Haitao;CAO Hanzhong;QIAN Yanning(Department of Anesthesiology,Tumor Hospital Affiliated to Nantong University,Nantong,Jiangsu 226361,China;Department of Anesthesiology,Rugao Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nantong,Jiangsu 226599,China;Department of Anesthesiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南通大学附属肿瘤医院麻醉科,江苏南通226361 [2]南京中医药大学如皋附属医院麻醉科,江苏南通226599 [3]南京医科大学第一附属医院麻醉科,江苏南京210029

出　　处：《现代医药卫生》2022年第2期192-195,200,共5页Journal of Modern Medicine & Health

基　　金：江苏省科学技术厅临床前沿技术项目(BE2018669);江苏省南通市科学技术局科技项目(HS13926)。

摘　　要：目的 探讨持续静脉镇痛对食管癌手术患者苏醒质量及早期认知功能的影响。方法 选择2016年1月至2018年12月在南通大学附属肿瘤医院择期行食管癌手术患者46例,随机分为硬膜外镇痛组(A组)和持续静脉镇痛组(B组)。比较2组视觉模拟量表(VAS)评分、布鲁格曼舒适量表(BCS)评分、术后恢复质量15项量表(QoR-15)评分等指标。结果 2组术毕自主呼吸恢复时间、苏醒时间、拔管时间、Steward苏醒评分达到6分时间比较,差异均无统计学意义(P>0.05)。B组拔管后24、48、72h苏醒期Ramsay镇静评分优于A组,差异均有统计学意义(P<0.05)。B组术后谵妄、认知功能障碍、苏醒期间躁动及镇痛引起的不良反应(皮肤瘙痒除外)发生率优于A组,差异均有统计学意义(P<0.05)。B组静息及运动时VAS、BCS评分及QoR-15评分优于A组,差异均有统计学意义(P<0.05)。结论 食管癌手术患者行持续静脉镇痛可有效改善患者苏醒质量,降低术后谵妄、认知功能障碍、苏醒期间躁动及镇痛引起的不良反应发生率,有利于患者早期下床活动,可提高患者治疗满意度及舒适度。Objective To investigate the effect of continuous intravenous analgesia on recovery quality and early cognitive function in patients with esophageal cancer.Methods 46 patients who underwent elective esophageal cancer surgery in the Tumor Hospital Affiliated to Nantong University from January 2016 to December 2018 were selected and randomly divided into epidural analgesia group(group A)and continuous intravenous analgesia group(group B).The visual analogue scale(VAS)score,Brugman Comfort Scale(BCS)score,postoperative recovery quality 15 item scale(QoR-15)score and other indicators were compared between the two groups.Results There were no significant differences between the two groups in the recovery time of spontaneous breathing,recovery time,extubation time and the time of Steward′s recovery score reaching 6 points after operation(P>0.05).The Ramsay sedation score in the group B was better than that in the group A at 24,48 and 72 hours after extubation(P<0.05).The incidences of delirium,cognitive impairment,restlessness during awakening and adverse reactions caused by analgesia(except skin pruritus)after operation in the group B were better than those in the group A,and the differences were statistically significant(P<0.05).The scores of VAS,BCS and QoR-15 at rest and during exercise in the group B were better than those in the group A(P<0.05).Conclusion Continuous intravenous analgesia in patients undergoing esophageal cancer surgery can effectively improve the quality of awakening,reduce the incidences of delirium,cognitive impairment,restlessness during awakening and adverse reactions caused by analgesia after operation,help patients get out of bed early,and improve patients′treatment satisfaction and comfort.

关 键 词：硬膜外镇痛 静脉镇痛 苏醒质量 早期认知功能 

分 类 号：R453.9[医药卫生—治疗学]