右美托咪定肋间神经阻滞对食管癌根治术患者术后疼痛的影响

Effect of dexmedetomidine intercostal nerve block on pain after radical resection of esophageal cancer

目的探讨右美托咪定肋间神经阻滞对食管癌根治术患者术后疼痛的影响。方法将90例2017年6月至2018年5月在徐州市中心医院进行食管癌根治术的患者作为研究对象。全部患者随机分为研究组和对照组,各45例。全部患者采用胸腹腔镜食管癌根治术治疗,术后采用肋间神经阻滞进行镇痛。对照组给予罗哌卡因注射液。研究组在对照组基础上,给予右美托咪定。于术后4、8、12、24 h,记录两组的生命体征指标(HR、MAP、SpO2);采用视觉模拟评分法(VAS)评估患者的疼痛程度;采用Ramsay镇静评分标准评估患者的镇静状态。检测两组患者血清5-羟色胺(5-HT)、P物质(SP)、β-内啡肽(β-EP)、神经肽Y(NPY)水平。记录两组的手术情况。结果术后4、8、12、24 h,两组的MAP、SpO2比较,差异无统计学意义(P>0.05);术后8、12、24 h,研究组的HR比对照组低,差异有统计学意义(P<0.05);术后8、12、24 h,研究组的VAS评分比对照组低,Ramsay评分比对照组高,差异有统计学意义(P<0.05);术后8、12、24 h,研究组的5-HT、SP、β-EP、NPY比对照组低,差异有统计学意义(P<0.05)。两组的手术时间、术中失血量、苏醒时间、胃肠功能恢复时间比较,差异无统计学意义(P>0.05)。结论右美托咪定肋间神经阻滞能进一步减轻食管癌根治术患者术后疼痛。

Objective To investigate the effect of dexmedetomidine intercostal nerve block on pain after radical resection of esophageal cancer.Methods A total of 90 patients who received radical resection of esophageal cancer in Xuzhou Central Hospital from June 2017 to May 2018 were selected and divided into study group and control group randomly(n=45,each).All patients were treated with thoracoscopic and laparoscopic radical esophagectomy and intercostal nerve block for analgesia.The control group was given ropivacaine injection.The study group was given dexmedetomidine on the basis of the control group.The vital signs(HR,MAP,SpO2) of the two groups were recorded at 4,8,12 and 24 hours after the operation.Visual analogue scale(VAS) was used to evaluate the degree of pain and Ramsay sedation score was used to evaluate the sedation status of the patients.Serum levels of 5-hydroxytryptamine(5-HT),substance P(SP),β-endorphin(β-EP) and neuropeptide Y(NPY) were measured in both groups.The operation conditions of the two groups were recorded.Results At 4,8,12 and 24 hours after operation,there was no significant difference in MAP and SpO2 between the two groups(all P>0.05).HR of the study group was significantly lower than that of the control group at 8,12 and 24 hours after operation(all P<0.05).At 8,12 and 24 hours after operation,the VAS score of the study group was significantly lower than that of the control group,and the Ramsay score was significantly higher than that of the control group(all P<0.05).At 8,12 and 24 hours after operation,5-HT,SP,β-EP and NPY in the study group were significantly lower than those in the control group(all P<0.05).There was no significant difference in operation time,intraoperative blood loss,recovery time and recovery time of gastrointestinal function between the two groups(all P>0.05).Conclusion Dexmedetomidine intercostal nerve block could further relieve pain after radical resection of esophageal cancer.