| Objective: Using the multimodal analgesia mode,this study takes patients with open chest surgery of esophageal cancer as the research object.This study analies the analgesic effect,the type of adverse reactions,the incidence of postoperative cognitive dysfunction and inflammatory factors(IL-6,S100β)changes.Methods: Fifty patients with elective esophageal cancer radical operation were selected from the Second People’s Hospitals of Hengshui City from January 2015 to December 2016,Patients were divided into two groups by the randomized digital method: model group(group M)and control(group C),and each group including 25 cases.All patients underwent total intravenous anesthesia.Following by sufentanil 0.3 μg / kg,propofol 1-1.5 mg / kg,etomidate 0.2-0.3 mg / kg,After the patient’s consciousness disappeared,intravenous cis-atracurium 0.2 mg / kg was given.Anesthesia was maintained by continuous infusion of 4~8 mg/(kg·h)propofol and 0.02~0.2 μg/(kg·min)remifentanil,and meanwhile intermittent bolus injection of 0.05 mg/kg cis-atracurium,with BIS value keeping between 45 and 60.Intraoperative infusion was conducted mainly using acetated Ringer’s solution and hydroxyethyl starch(130\0.4),and intraoperative blood pressure fluctuated at±30% of base blood pressure.Before the chest was closed,50 mg flurbiprofen axetil was intravenously injected.After surgery,anaesthetics were stopped.Before the chest was closed,intercostal nerve block was performed at the incision and intercostal space between the two ribs above and under the incision by surgeons;and 3~5 ml was injected at the anterior axillary line,the midaxillary line and the posterior axillary line,respectively.group M : 20 ml0.75% ropivacaine and 1 μg/kg dexmedetomidine diluted with physiologicalsaline to 40 ml.Group C was injected with 40 ml physiological saline at the same injection point of corresponding intercostal space.Followed by analgesic pump,group M: sufentanil 2 μg / kg + dexmedetomidine 1.5 μg / kg + tropisetron 5 mg,saline diluted to 150 ml,pump speed2 ml / h,PCA3 ml,The interval time was 15 min.The analgesic time was 48h;the group C: sufentanil 2μg / kg + tropisetron 5mg,saline diluted to 150 ml,other parameters set with the group M.General data(gender,age,weight,duration of education,location of esophageal cancer,pathological type and ASA grade),perioperative period index(operation time,wake time,intraoperative blood loss,urine output,infusion volume)were recorded.The simulated visual acuity(VAS)score and Ramsay sedation grade were performed at 4h,8h,12 h,24h,48 h after awakening.Record the effective number of self-controlled pressing of PCA within 48 hours after operation.The content levels of IL-6 and S100β were detected at day 1 before operation and at 6 hours after operation.Using the Simple Mental State Scale(MMSE)the patient’s mental state scores were measured at day 1 before operation and day 1,3,7 after operation.Record the incidence of adverse reactions.Results: There were no significant differences in gender,age,body weight,years of education,location of lesion,pathological type and ASA grade in group M and group C(P>0.05).There were no significant differences in the operation time,recovery time,intraoperative blood loss,urine volume and infusion volume between group M and group C(P> 0.05).There were no significant differences in VAS scores between group M and group C at 4h,8h,12 h,24h and 48 h after awakening(P> 0.05).There was no significant differences in the sedation and grading of Ramsay between group M and group C at 4h,8h,12 h,24h and 48 h after awakening(P> 0.05).There was no significant differences in the content levels of IL-6 and S100β between group M and group C at day 1 before operation(P> 0.05).The content levels of IL-6and S100β in group M were significantly lower than those in group C at 6h and day 3 after operation(P<0.05).There was no significant differences inMMSE score between group M and group C at day 1 before operation(P>0.05).The MMSE score of group M was significantly higher than that of group C at day 1,3,7 after operation(P<0.05).The incidence of POCD in the group M was significantly lower than that of group C at day 1,3,7 after operation(P<0.05).There was no significant differences in the incidence of postoperative adverse reactions between group M and group C(P> 0.05).Conclusions: Multimodal analgesia can help reduce the content level of IL-6 and S100β after thoracotomy for esophageal cancer patients,improve postoper-ative cognitive function and reduce the incidence of postoperative cognitive dysfunction. |
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