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
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摘要
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.
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.
引文
[1]Gill MR,Jarman PJ,Halder S,et al.A three-in-one-bullet for oesophageal cancer:replication fork collapse,spindle attachment failure and enhanced radiosensitivity generated by a ruthenium(ii)metallo-intercalator[J].Chem Sci,2017,9(4):841-849.
[2]李众.全麻复合硬膜外阻滞在食管癌根治术及术后镇痛中的应用[J].中国医药指南,2016,14(23):80.
[3]刘媛媛,刘福垒.右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析[J].安徽医药,2016,20(10):1940-1943.
[4]叶绍兵,魏勤,陈强,等.硬膜外复合全身麻醉对开胸手术患者血流动力学和应激反应的影响研究[J].现代生物医学进展,2018,18(4):691-694.
[5]徐磊,李志鹏.椎旁神经阻滞复合全麻对食管癌根治术患者围手术期血糖、β-内啡肽、TNF-α和IL-6水平的影响[J].现代中西医结合杂志,2018,27(8):892-895.
[6]辜晓岚,何建华,顾连兵,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].临床麻醉学杂志,2015,31(1):18-21.
[7]徐斌.超声引导下连续椎旁神经阻滞对开胸手术患者术后镇痛及炎性反应的影响[J].微创医学,2016,11(3):400-401,426.
[8]庆淑梅,曹亚楠,孙振涛,等.椎旁神经阻滞用于开胸术老年患者超前镇痛的效果[J].中华麻醉学杂志,2016,36(2):168-170.
[9]巩红岩,段文姣,刘景景,等.超声引导连续胸椎旁神经阻滞复合右美托咪定麻醉对食管癌手术患者围术期应激反应的影响[J].新乡医学院学报,2016,33(4):291-296.下转第页
[10]章蔚,柴小青,魏昕,等.Narcotrend监测下全身麻醉复合椎旁神经阻滞用于胸腹腔镜联合食管癌根治术效果观察[J].山东医药,2016,56(40):72-74.
[11]Fan RH,Guo JN,Yan W,et al.Small nucleolar host gene6 promotes esophageal squamous cell carcinoma cell proliferation and inhibits cell apoptosis[J].Oncol Lett,2018,15(5):6497-6502.
[12]池瀚,周红梅,符新春,等.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[J].中国临床保健杂志,2018,21(1):40-43.
[13]韩灵龙.胸椎旁神经阻滞联合全麻在食管癌手术中的临床研究[J].中国现代药物应用,2016,10(18):188-189.
[14]王莉娟,马民玉,孙振涛,等.帕瑞昔布钠联合超声引导椎旁神经阻滞用于胸科手术多模式镇痛的临床研究[J].中华实验外科杂志,2016,33(9):2223-2226.
[15]巩红岩,郑芳,刘景景,等.超声引导连续胸椎旁神经阻滞镇痛对食管癌手术患者围手术期应激反应的影响[J].中国医师进修杂志,2016,39(5):456-460.
[16]曾凌竹,余云明.右美托咪定用于胸椎旁神经阻滞对老年开胸手术患者氧化应激及炎性反应的影响[J].现代中西医结合杂志,2017,26(32):3629-3632.
[17]梁友君,褚立君,龙先铭.超声引导下经连续椎旁神经阻滞复合全麻对开胸手术患者炎性反应和血流动力学的影响[J].中国医学装备,2018,15(7):99-103.
[18]马伯元,周春兰,张芳芳,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].世界最新医学信息文摘,2016,16(48):71-72.
[19]黄丹,周斌,肖凡,等.右美托咪定行胸椎旁神经阻滞对开胸手术患者应激反应的影响[J].中国现代医学杂志,2017,27(14):87-92.
[20]耿红芳,丛旭晖,张伟,等.麻醉因素与开胸食管癌根治术患者术后细胞免疫功能的关系:胸椎旁神经阻滞联合全身麻醉的价值[J].中华麻醉学杂志,2017,37(6):641-644.
[21]李冰,白耿研,范卫英,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响探讨[J].基层医学论坛,2018,22(1):33-34.
[2]李众.全麻复合硬膜外阻滞在食管癌根治术及术后镇痛中的应用[J].中国医药指南,2016,14(23):80.
[3]刘媛媛,刘福垒.右美托咪定联合胸椎旁神经阻滞应用于开胸食管癌根治术术后镇痛效果分析[J].安徽医药,2016,20(10):1940-1943.
[4]叶绍兵,魏勤,陈强,等.硬膜外复合全身麻醉对开胸手术患者血流动力学和应激反应的影响研究[J].现代生物医学进展,2018,18(4):691-694.
[5]徐磊,李志鹏.椎旁神经阻滞复合全麻对食管癌根治术患者围手术期血糖、β-内啡肽、TNF-α和IL-6水平的影响[J].现代中西医结合杂志,2018,27(8):892-895.
[6]辜晓岚,何建华,顾连兵,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].临床麻醉学杂志,2015,31(1):18-21.
[7]徐斌.超声引导下连续椎旁神经阻滞对开胸手术患者术后镇痛及炎性反应的影响[J].微创医学,2016,11(3):400-401,426.
[8]庆淑梅,曹亚楠,孙振涛,等.椎旁神经阻滞用于开胸术老年患者超前镇痛的效果[J].中华麻醉学杂志,2016,36(2):168-170.
[9]巩红岩,段文姣,刘景景,等.超声引导连续胸椎旁神经阻滞复合右美托咪定麻醉对食管癌手术患者围术期应激反应的影响[J].新乡医学院学报,2016,33(4):291-296.下转第页
[10]章蔚,柴小青,魏昕,等.Narcotrend监测下全身麻醉复合椎旁神经阻滞用于胸腹腔镜联合食管癌根治术效果观察[J].山东医药,2016,56(40):72-74.
[11]Fan RH,Guo JN,Yan W,et al.Small nucleolar host gene6 promotes esophageal squamous cell carcinoma cell proliferation and inhibits cell apoptosis[J].Oncol Lett,2018,15(5):6497-6502.
[12]池瀚,周红梅,符新春,等.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[J].中国临床保健杂志,2018,21(1):40-43.
[13]韩灵龙.胸椎旁神经阻滞联合全麻在食管癌手术中的临床研究[J].中国现代药物应用,2016,10(18):188-189.
[14]王莉娟,马民玉,孙振涛,等.帕瑞昔布钠联合超声引导椎旁神经阻滞用于胸科手术多模式镇痛的临床研究[J].中华实验外科杂志,2016,33(9):2223-2226.
[15]巩红岩,郑芳,刘景景,等.超声引导连续胸椎旁神经阻滞镇痛对食管癌手术患者围手术期应激反应的影响[J].中国医师进修杂志,2016,39(5):456-460.
[16]曾凌竹,余云明.右美托咪定用于胸椎旁神经阻滞对老年开胸手术患者氧化应激及炎性反应的影响[J].现代中西医结合杂志,2017,26(32):3629-3632.
[17]梁友君,褚立君,龙先铭.超声引导下经连续椎旁神经阻滞复合全麻对开胸手术患者炎性反应和血流动力学的影响[J].中国医学装备,2018,15(7):99-103.
[18]马伯元,周春兰,张芳芳,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].世界最新医学信息文摘,2016,16(48):71-72.
[19]黄丹,周斌,肖凡,等.右美托咪定行胸椎旁神经阻滞对开胸手术患者应激反应的影响[J].中国现代医学杂志,2017,27(14):87-92.
[20]耿红芳,丛旭晖,张伟,等.麻醉因素与开胸食管癌根治术患者术后细胞免疫功能的关系:胸椎旁神经阻滞联合全身麻醉的价值[J].中华麻醉学杂志,2017,37(6):641-644.
[21]李冰,白耿研,范卫英,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响探讨[J].基层医学论坛,2018,22(1):33-34.