肋间神经阻滞在食管癌术后镇痛效果研究

Clinical study of intercostals nerve block in the postoperative analgesia after esophageal cancer resection

目的观察肋间神经阻滞在食管癌手术术后镇痛中的效果。方法60例食管癌择期手术患者，随机分成3组。A组患者术毕关胸前进行肋间神经阻滞（INB），B组患者进行自控静脉镇痛（PCIA），C组采用INB＋PCIA的联合镇痛方式。记录术后1、4、24、48h手术切口疼痛视觉模拟评分（VAS），术后24h芬太尼用量、PCIA的有效按压次数，观察术后不良反应发生情况。结果①镇痛评分结果：术后1h，B组VAS镇痛评分明显高于A、C组（P〈0．05）；C组患者在术后4、24h的镇痛评分低于A、B组（P〈0．05）；术后48h，A组VAS评分最高（P〈0．05），B、c组间差异无统计学意义（P〉0．05）。②术后24h芬太尼用量和有效按压次数：B组24h时芬太尼用量及各时间点前有效压次数均高于c组（P〈0．05或P〈0．01）。③B组发生恶心、呕吐及呼吸抑制等不良反应。结论肋间神经阻滞联合静脉自控镇痛能明显提高食管癌切除术患者术后急性疼痛镇痛效果，减少阿片类镇痛药的用量，降低镇痛评分。

Objective To investigate the effects of intercostals nerve block （INB） in the postoperative analgesia af- ter esophageal cancer resection. Methods A total of 60 esophageal carcinoma patients who scheduled to undergo surgery were randomly divided into three groups. Patients in Group A underwent INB at the end of surgery. Group B was provided with patient - controlled intravenous analgesia （PCIA）. Group C received INB combined with PCIA. Then, their visual analogue score （VAS） at the incision site 1,4, 24 and 48 hours after surgery, the dose of fentany124 hour after surgery, the number of effective compressions and adverse reaction were recorded. Results Group B presented remarkably higher VAS than Groups A and C 1 hour after surgery （ P 〈 0.05 ）, while Group C produced significantly lower VAS than Groups A and B 4 and 24 hours after surgery （P 〈 0.05 ）. The highest VAS was found in Group A 48 hours after surgery, when no statistical difference was seen in VAS between Groups B and C （P 〉 0.05）. Furthermore, compared with Group C, Group B required larger doses of fentanyl 24 hour after surgery and a higher number of effective compressions at each time point （P 〈0.05 or P 〈0.01 ）. Also, nausea, vomiting and respiratory inhabitation were reported in Group B alone. Conclusion The combination of INB and PCIA can obviously improve the analgesic effects of patients after esophageal cancer resection, reducing the dose of opioids and VAS.