超声引导下连续椎旁神经阻滞对老年食管癌手术患者术后恢复的影响

The effect of ultrasound-guided continuous paraspinal nerve block on postoperative recovery of elderly patients with esophageal cancer

目的研究超声引导下连续椎旁神经阻滞对老年食管癌手术患者术后恢复的影响。方法选取2016年4月～2018年2月在河北省沧州市中心医院行择期食管癌手术的老年患者84例为研究对象。将所有患者根据随机数字表法分为观察组与对照组,每组42例。对照组采用单纯全身麻醉处理,观察组采用超声引导下连续椎旁神经阻滞复合全身麻醉处理。分别比较两组患者术后康复情况,不同时间点两组患者血流动力学指标水平变化情况、应激指标水平变化情况,术后不同时间点两组疼痛情况,手术时间以及瑞芬太尼、异丙酚使用剂量情况。结果观察组肛门排气时间、排便时间、住院时间均明显短于对照组,差异有统计学意义(P <0.05)。手术1 h、手术2 h时观察组的收缩压、舒张压水平均明显高于对照组,而在手术2 h、术毕时观察组心率水平均明显低于对照组,差异有统计学意义(P <0.05)。观察组术后24 h的去甲肾上腺素水平明显低于对照组,且手术2 h、术毕及术后24 h的肾上腺素、多巴胺水平均明显低于对照组,差异有统计学意义(P <0.05)。观察组患者术后1、4、8、24 h的视觉模拟评分均明显低于对照组,差异有统计学意义(P <0.05)。观察组瑞芬太尼与异丙酚用量均明显低于对照组,差异有统计学意义(P <0.05)。结论超声引导下连续椎旁神经阻滞应用于老年食管癌手术患者中效果明显,能有效促进患者术后恢复,维持血流动力学稳定,有利于抑制应激反应,并减轻患者术后疼痛以及瑞芬太尼、异丙酚用量,值得临床推广应用。

Objective To study the effect of ultrasound-guided continuous paraspinal nerve block on postoperative recovery of elderly patients with esophageal cancer.Methods Eighty-four cases of elderly patients with esophageal cancer enrolled in Cangzhou Central Hospital of Hebei Province from April 2016 to February 2018 were divided into observation group and control group according to the random number table method,with 42 cases in each group.The control group was treated with simple general anesthesia,the observation group was treated with ultrasound-guided continuous paraspinal nerve block combined with general anesthesia.The postoperative recovery,the changes of hemodynamic indexes and stress indicators at different time points,the postoperative pain situation at different time points,surgery time and dosage of Remifentanil and Propofol were compared in the two groups.Results The anal exsufflation time,defecation time and hospitalization time of the observation group were significantly shorter than those of the control group,the differences were statistically significant(P<0.05).The systolic blood pressure and diastolic blood pressure level in the observation group of intraoperative 1 h and 2 h were significantly higher than those in the control group,and the heart rate of the observation group of intraoperative 2 h and at the end of operation were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The level of norepinephrine in the observation group of postoperative 24 h was significantly lower than that in the control group,and the levels of adrenaline and dopamine in the observation group of intraoperative 2 h,the end of operation and postoperative 24 h were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The visual analog scores of postoperative 1,4,8 h and 24 h in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The dosage of Remifentanil and Propofol in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided continuous paravertebral nerve block is effective in the treatment of elderly patients with esophageal cancer,it is effective to promote postoperative recovery of patients,maintain hemodynamic stability and inhibit the stress response,it can also relieve postoperative pain and the dosage of Remifentanil and Propofol,it is worthy of clinical application.