肋间神经阻滞联合静脉自控镇痛对食管癌患者术后疼痛的抑制及血浆β-EP、TGF-β1的影响

Effects of intercostal nerve block combined with patient-controlled intravenous analgesia on postoperative pain and plasma β-EP,TGF-β1 levels in esophageal cancer patients

目的:分析肋间神经阻滞联合静脉自控镇痛对食管癌患者术后疼痛的抑制及血浆β-内啡肽(β-EP)、转化生长因子-β1(TGF-β1)的影响。方法:选择2014年9月至2017年1月在本院就诊的92例食管癌患者,按随机数字表法分为对照组和研究组,每组46例。对照组予以静脉自控镇痛,研究组在对照组的基础上加以肋间神经阻滞镇痛,比较两组视觉模拟疼痛评分(VAS)、β-EP、TGF-β1,平均动脉压(MAP)、心率(HR)、二氧化碳分压(PCO2)、氧分压(PaO2)及不良反应情况。结果:两组术后VAS评分、TGF-β1、MAP、HR、PCO2均较术前上升(P<0.05),研究组均明显低于对照组(P<0.05),两组术后β-EP、PaO2均较术前上升(P<0.05),研究组均高于对照组(P<0.05)。两组术后均有呼吸抑制、恶心呕吐、皮肤瘙痒发生,但两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:肋间神经阻滞联合静脉自控镇痛对食管癌患者术后疼痛的控制效果优于单用静脉自控镇痛,能够利于血浆β-EP分泌,降低TGF-β1水平,抑制疼痛传递,且未增加患者不良反应,为术后疼痛的有效镇痛方式。

Objective:To analyze the effects of intercostal nerve block combined with patien-controlled in-travenous analgesia(PCIA)on postoperative pain and plasmaβ-endorphin(β-EP),transforming growth factor-β1(TGF-β1)levels in patients with esophageal cancer.Methods:92 patients with esophageal cancer underwent surgery in our hospital from September 2014 to January 2017 were selected and randomly divid-ed into a control group and a research group,with 46 cases in each group.The patients in the control group were given PCIA,while those in the research group were given intercostal nerve block combined with PCIA.The visual analogue scale(VAS),β-EP,TGF-β1,mean arterial pressure(MAP),heart rate(HR),CO2 par-tial pressure(PCO2),oxygenpartial pressure(PaO2),and the incidence of adverse reactions between the two groupswere compared.Results:The VAS,TGF-β1,MAP,HR and PCO2 after surgery inboth group were increased,and were lower in the research group than those in the control group(P〈0.05).β-EP level in plasma and PaO2 after surgery in both groups were decreased,andwere higher in the research group than those in the control group(P〈0.05).Respiratory inhibition,nausea vomiting and skin itching were noted in the two groups.There was no significant difference in the incidence of adverse reactions between the two group(P>0.05).(Conclusion:Effect of intercostal nerve block combined with PCIA on postoperative pain was better than PCIA only in patients with esophageal cancer.This combination could elevate plasmaβ-EP level reduce TGF-β1 level inhibit pain transmission,and did not increase the incidence of adverse reactions.