摘要
目的探讨椎旁阻滞术联合全身麻醉对结肠癌根治术后患者镇痛效果及应激反应水平的影响。方法纳入2014-11—2016-10于解放军第91医院行结肠癌根治术手术治疗患者90例。根据麻醉方式的不同采用随机对照的方式将患者分为单纯全麻组(G组,45例)和椎旁阻滞联合全身麻醉组(PG组,45例)。比较两组患者术后镇痛效果和应激反应水平的差异。结果两组患者入组时一般临床资料比较差异均无统计学意义(均P>0.05)。术前两组疼痛评分,血清炎症因子及应激激素浓度差异均无统计学意义(均P>0.05)。但PG组术后3 h(t=3.132,P=0.002)和术后24 h(t=2.796,P=0.006)VAS疼痛评分均显著性低于G组。同时,PG在术后3 h及术后24 h血清炎症因子TNFα(t=5.961,2.586;P=0.000,0.011),CRP(t=3.709,2.992;P=0.000,0.004)以及血清应激激素Cor(t=2.206,2.935;P=0.029,0.004),AngⅡ(t=3.847,3.551;P=0.000,0.001)浓度均显著性低于G组。两组患者术后恶心呕吐,拔管时间,ICU时间及住院天数等方面差异均无统计学意义(P>0.05)。结论椎旁阻滞术可以有效改善结肠癌根治术后镇痛效果,并能有效降低机体应激反应水平。
Objective To investigate the influence of paravertebral block combined with general anesthesia on postoperation analgesic effect and stress reaction level in sufferers with colon cancer radical operation. Methods 90 sufferers undergoing colon cancer radical operation at No.91 PLA Hospital from Nov.2014 to Oct.2016 were selected and randomized divided into 2 groups according to anesthesia methods：general anesthesia group（G group, 45 cases） and paravertebral block combined with general anesthesia group （PG group,45 cases）. Differences in postoperative analgesia effect and stress reaction level were compared between the two groups. Results No significant differences in clinical data during admission were observed between the two groups（all P〉 0.05）.No significant differences were observed in pain scores, serum inflammatory factors and stress hormone concentrations between the two groups before surgery（all P〉0.05）.But the VAS pain scores 3 hours（t=3.132, P=0.002） and 24 hours（t=2.796, P=0.006） after surgery in the PG group were significantly lower than the G group.Meanwhile, the scores of serum inflammatory factors of TNFCt （t=-5.961,2.586 ; P= 0.000,0.011 ） and CRP（t= 3.709,2.992 ; P= 0.000,0.004） and serum stress hormone concentrations of Cor （ t = 2.206,2.935 ; P = 0.029 , 0.004） and Ang II （t = 3.847,3.551 ; P = 0.000 , 0.001 ） 3 hours and 24 hours aider surgery in the PG group were significantly lower than the G group.The differences of nausea and vomiting, extubation time, ICU time and length of stay in both groups showed no statistical significance（P〉 0.05）.Conclusion Paravertebral block can effectively improve the postoperative analgesic effect and reduce the stress reaction level in sufferers with colon cancer radical operation.
出处
《中国疗养医学》
2017年第5期462-465,共4页
Chinese Journal of Convalescent Medicine
关键词
椎旁阻滞
结肠癌根治术
镇痛
应激反应
Paravertebral block
Colon cancer radical operation
Analgesia
Stress reaction
