连续椎旁神经阻滞对食管癌根治术中血流动力与术后镇痛效果和炎性因子水平的影响

Effect on intraoperative hemodynamics,postoperative analgesia and inflammatory factor of continuous lateral nerve block for esophagectomy

目的观察连续椎旁神经阻滞应用于食管癌根治术对患者术中血流动力学与术后镇痛效果和炎性因子水平的影响。方法将80例食管癌根治术患者按照随机数字表法平均分为两组,对照组行气管内插管全身麻醉,观察组采取全身麻醉联合连续椎旁神经阻滞。比较两组术中血流动力学指标如平均动脉压(MAP)、心率(HR)、手术不同时刻[诱导前(T0)、插管即刻(T1)、切皮时(T2)、术中1h(T3)、手术结束即刻(T4)、拔管即刻(T5)]炎性因子水平、术后疼痛情况。结果观察组T2、T3、T4时刻MAP及HR水平均低于对照组,对照组T1、T2、T3、T4时刻MAP及HR水平均高于T0时刻(P<0.05);观察组手术结束即刻、术后12 h、术后24 h及术后48 h白细胞介素-6、白细胞介素-8及肿瘤坏死因子α水平均低于对照组(均P<0.05);观察组手术结束即刻、术后6 h、术后12 h、术后24 h、术后48 h视觉模拟评分均低于对照组(P<0.05);两组不良反应比较,差异无统计学意义(P>0.05)。结论连续椎旁神经阻滞应用于食管癌根治术血流动力学稳定,且降低机体炎性因子水平,术后疼痛程度低。

Objective To observe effect on intraoperative hemodynamics,postoperative analgesia and inflammatory factor of continuous lateral nerve block for esophagectomy. Methods Eighty patients with esophagectomywere randomly divided into 2 groups:control group( n = 40) choose general anesthesia,observation group( n = 40) choose general anesthesia combined continuous lateral nerve block. The intraoperative hemodynamic indexes such as the mean arterial pressure( MAP),heart rate( HR),inflammatory factor in different time of operation,postoperative pain of two groups were compared. Results MAP and HR of observation group at T2,T3,T4 moment were lower than those of the control group,MAP and HR of control group at T1,T2,T3,T4 moment were higher than T0 time( P < 0. 05). Interleukin6,8 and tumor necrosis factor alpha levels of operation group were higher than control group( all P < 0. 05) at end immediately,12 h and 24 h after surgery and postoperative 48 h;VAS scores of operation group at end immediately,6 h,12 h,24 h after surgery,postoperative 48 h were lower than the control group( P < 0. 05). The adverse reactions of two groups had no statistically significant difference( P > 0. 05). Conclusion Continuous lateral nerve block used in esophagectomy can maintain hemodynamics steadily,and reduce the body's inflammatory factor levels,lower pain grade.