静脉镇痛联合肋间神经阻滞对老年食管癌患者术后疼痛及认知功能的影响

Effect of intercostal nerve block with ropivacaine followed by patient-controlled analgesia infusion pump on postoperative pain and cognitive function in elderly patients with esophageal carcinoma

目的探讨静脉镇痛联合肋间神经阻滞对老年食管癌患者术后疼痛及认知功能的影响。方法将2014年5月—2016年5月间经浙江省肿瘤医院临床确诊后进行治疗的92例老年食管癌患者选择为临床研究病例,根据就诊顺序编号,并按单双号分成2组。对照组(单号)46例仅给予术后静脉镇痛泵治疗,观察组(双号)46例给予罗哌卡因行肋间神经阻滞联合应用静脉镇痛泵治疗。比较2组智力检查评分(MMSE)、疼痛评分(VAS)、舒适评分(BCS)以及认知功能障碍(POCD)发生率。结果观察组MMSE[(24.79±2.66)分]以及POCD发生率(8.70%)明显优于对照组[MMSE(20.87±2.43)分、POCD发生率(26.09%)],差异有统计学意义(P<0.05)。观察组苏醒后1 h静息VAS[(0.44±0.08)分]、运动VAS[(1.42±0.36)分]、BCS[(3.76±1.95)分],苏醒后24h静息VAS[(2.23±1.92)分]、运动VAS[(3.79±2.66)分]、BCS[(2.55±1.43)分]明显优于对照组[苏醒后1h静息VAS(1.78±1.28)分、运动VAS(3.47±1.23)分、BCS(2.56±1.88)分,苏醒后24 h静息VAS(4.18±1.88)分、运动VAS(6.87±2.43)分、BCS(1.83±1.12)分],差异有统计学意义(P<0.05)。结论老年食管癌患者术后应用罗哌卡因肋间神经阻滞联合静脉镇痛泵治疗,能够有效减轻术后疼痛,显著改善认知功能障碍,提高患者整体生活质量。

Objective To explore the effect of intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia( PCA) infusion pump on postoperative pain and cognitive function in elderly patients with esophageal carcinoma. Methods Ninety-two elderly patients clinical diagnosed with esophageal carcinoma in our hospital were selected as the clinical research subjects,and the patients were numbered according to treatment order,and divided into two groups according to odd and even number. The 46 cases in the control group( odd) were treated with postoperative intravenous analgesia pump,and the other 46 cases in the observation group( even) received intercostal nerve blockade with ropivacaine followed by analgesia infusion pump. Intelligence examination scores( MMSE),pain score( VAS),comfort score( BCS) and incidence of cognitive impairment( POCD) were compared between the two groups. Results The MMSE score( 24. 79 ± 2. 66) and POCD incidence( 8. 70%) in the observation group was significantly better than those in the control group [MMSE score( 20. 87 ± 2. 43) and POCD incidence( 26. 09%) ],and the differences were statistically significant( P < 0. 05). The VAS at rest( 0. 44 ± 0. 08),VAS at movement( 1. 42 ± 0. 36),and BCS( 3. 76 ± 1. 95) in one hour after awakening,the VAS at rest( 2. 23 ± 1. 92),VAS at movement( 3. 79 ± 2. 66),and BCS( 2. 55 ± 1. 43) % in 24 h after awakening in the observation group recovered significantly better than the control group[VAS at rest( 1. 78 ± 1. 28),VAS at movement( 3. 47 ± 1. 23),and BCS( 2. 56 ± 1. 88) points in one hour after awakening,the VAS at rest( 4. 18 ±1. 88),VAS at movement( 6. 87 ± 2. 43),and BCS( 1. 83 ± 1. 12) points in 24 h after awakening],and the differences were statistically significant( P < 0. 05). Conclusion Postoperative intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia infusion pump for elderly patients with esophageal carcinoma can effectively reduce postoperative pain,significantly improve postoperative cognitive function,and improve the overall life quality of patients.