超声引导下连续椎旁神经阻滞在老年食管癌术后镇痛中的应用价值

目的 探讨超声引导下连续椎旁神经阻滞(PVNB)对老年食管癌开胸手术患者术后镇痛、应激及炎性因子水平的影响.方法 选取我院拟实施全身麻醉下开胸手术的90例老年食管癌患者为研究对象,其中45例术前行超声引导下PVNB麻醉复合全身麻醉(PVNB组),45例采用单纯全身麻醉(对照组).两组患者术后均采用静脉自控镇痛,比较术后...

Application value of ultrasound-guided continuous paravertebral nerveblock for postoperative analgesia in the elderly with esophageal cancer

Objective To explore the effects of ultrasound-guided continuous paravertebral nerve block(PVNB)on displacement analgesia,stress and inflammatory factors in elderly patients undergoing thoracotomy for esophageal cancer.Methods Ninety patients with esophageal cancer underwent thoracotomy under general anesthesia in our hospital were selected.Among them,45 patients underwent preoperative ultrasound-guided PVNB anesthesia combined with general anesthesia(PVNB group),and the rest 45 patients received general anesthesia(control group).Patients of both groups were treated with intravenous patient-controlled analgesia after surgery.The visual analogue pain score(VAS)during the resting state and cough state at 2 h,6 h,24 h and 48 h after surgery,the dosage of analgesic drugs and the occurrence of adverse drug reactions were compared between the two groups.The level of NE,E,Cor,IL-6,IL-10,TNF-αin serum before and 24 h after surgery,and the occurrence of postoperative lung infections were compared between the two groups.Results The VAS of the PVNB group was significantly lower than that of the control group in the resting state and cough state at 2 h,6 h,and 12 h after the operation(all P<0.05).The usage of postoperative analgesic pump and the amount of sufentanil were significantly lower than those of the control group(both P<0.05).There were no significant difference in the level of NE,E,Cor,IL-6,IL-10,and TNF-αin serum between the two groups before surgery.The levels of NE,E,Cor,IL-6,and TNF-αin serum of PVNB group were significantly lower than those of control group 24 h after surgery(P<0.05).The level of IL-10 of PVNB group was higher than that of the control group,but there was no significant difference.Two cases of pulmonary infections were found in the PVNB group,6 cases in the control group,and the difference between the two groups was statistically significant(4.4%vs.13.3%,P<0.05).Conclusion Ultrasound-guided PVNB can improve postoperative analgesia,reduce the stress response caused by surgical trauma,and reduce the incidence of postoperative lung infections in elderly patients with esophageal cancer after thoracotomy.