不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响

目的探讨不同镇痛方法对老年食管癌患者术后疼痛及认知功能的影响。方法选择拟行左进胸食管癌根治术患者60例,男31例,女29例,年龄65~80岁,ASAⅠ或Ⅱ级,随机分为A、B两组,每组30例。A组:关胸前予以0.375%罗哌卡因行肋间神经阻滞后接静脉镇痛泵,配方为舒芬太尼3μg/kg+氟比洛芬酯100mg,泵速2ml/h,自控镇痛0.5ml/按压,锁定时间15min。B组:关胸前予以舒芬太尼10μg+氟比洛芬酯50mg为负荷量后接静脉镇痛泵,配方同A组。观察两组患者术前1d、术后3、5、7d内简易精神状态量表(MMSE)评分,术后苏醒时、苏醒后4、8、12、24、48h视觉模拟疼痛(静息及运动时VAS)评分、BCS舒适评分、术后镇痛泵有效按压次数及术后认知功能障碍(POCD)的发生率。结果与B组比较,A组术后苏醒时、苏醒后4、8、12、24、48h静息及运动时VAS评分均明显降低(P0.05或P0.01);苏醒后4、8、12、24、48h的BCS评分明显升高、有效按压次数明显降低(P0.05);术后3、5、7d的MMSE评分明显升高(P0.05);术后3、5、7d的POCD发生率降低,但差异无统计学意义。结论开胸手术围术期应用肋间神经阻滞复合静脉镇痛可有效缓解患者术后疼痛,降低术后POCD的发生率,提高术后患者舒适度,有利于术后患者的快速康复。

Effects of ultimodal nalgesia on postoperative pain and postoperative cognitive function in elderly patients undergoing esophageal cancer

Objective To investigate the effects of a variety of different methods of analgesia on postoperative pain and cognitive function in elderly esophageal cancer patients.Methods Sixty elderly pa-tients scheduled for the left into the thoracic esophageal cancer surgery were randomly divided into two groups (n =30).Group A:Before the closure of thoracic cavity to block intercostal nerve with 0.375% rop-ivacaine,followed by intravenous pumps for analgesia,formulation of sufentanil 3 μg/kg+flurbiprofen 100 mg,pump speed 2 ml/h,self-controlled analgesia 0.5 ml/pressing,locking time 15 min.Group B:Before the closure of thoracic cavity given sufentanil 10 μg+flurbiprofen 50 mg as loading dose followed by epidural analgesia pump,recipe with group A.Two groups were observed mini mental state examination (MMSE) score 1 d before surgery and 3,5,7 d after surgery,each time point visual analogue pain score (resting and exercise VAS)score postoperative within 48 h,BCS comfort score and effective pressing times of postopera-tive analgesia pump.Results Compared with group B,the rest and exercise VAS scores of group A at post-operative recovery,4,8,12,24,48 h were significantly lower (P <0.05);the BCS scores of group A at postoperative 4,8,12,24,48 h were significantly higher (P <0.05);the pressing times of group A at postoperative 4,8,12,24,48 h were significantly reduced (P <0.05);the MMSE scores of group A at postoperative 3,5,7 d were significantly higher (P <0.05);the incidence of POCD of group A on postop-erative 3,5,7 d were significantly lower.Conclusion Thoracic surgery perioperative multimodal analgesia (intercostal nerve block and intravenous analgesia)can relieve postoperative pain,reduce the incidence of POCD,improve the postoperative patient comfort and help postoperative patients with rapid recovery.