| BackgroundAcute gastrointestinal injury(AGI)always appears in the critical care patients.It’s incidence is 60%～70%,Patients with AGI has a higher risk of mortality than others.However,treatments for AGI is limited,which respond poorly.Treatments involves early enteral nutrition,gastrointestinal motility drugs,post-pyloric feeding,gastrointestinal rehabilitation and traditional Chinese medicine.Nowadays,medical scientists find a fact that nerve block can improve gastrointestinal function of patients with AGI.According to study,Celiac plexus block and stellate ganglion block not only can improve gastrointestinal function,but also can reduce opioid requirement In recent years,erector spinae plane block(ESPB)had been suggested in clinical series,which has minimal trauma,quick recovery,simple operation and a lower risk of complication.Therefore,the critical patients with AGI were treated with ESPB in this study,and we evaluated the effect of ultrasound-guided ESPB on patients with AGI.Objective1.To evaluate whether ultrasound-guided ESPB could improve gastrointestinal function and reduce the AGI score of critical patients with AGI.2.To evaluate whether ultrasound-guided ESPB could reduce the requirement of opioids requirement of critical patients with AGI.3.To evaluate whether ultrasound-guided ESPB could reduce the requirement of 28th day mortality of critical patients with AGI.4.To evaluate the safety assessments of ultrasound-guided ESPB.MethodsThis was a randomized controlled clinical trial which was conducted in ICU of Zhu jiang Hospital of Southern Medical University.All patients(n=69)admitted with AGI were included in this study from September 2019 to November 2020.Patients with AGI were randomly allocated to receive ESPB(n=34)or non ESPB(NESPB,n=35).ESPB group could accept ESPB and conventional treatment,and NESPB group only received conventional treatment ESPB group received ultrasound-guided ESPB in the bilateral 8th thoracic vertebra(T8),with 75mg/l0ml ropivacaine as a single dose.After the single injection,34.5mg/20ml ropivacaine was used to continuously inject in erector spinae plane.The treatment will last for 7 days.We set 5 observation points at the time of beginning and 1st,3rd,5th and 7th days after admission into group.The primary outcome is the dose of opioids,and of thers outcomes included The AGI grade,gastrointestinal function score,intra-abdominal pressure,the diameter of transverse colon,inflammatory factor,28-mortality,length of stay in ICU,cost of stay in ICU,length of stay in hospital and cost of stay in hospital.ResultsDuring September 2019 to November 2020,1580 patients in ICU accepted AGI screening,and 69 individuals met the criteria for inclusion.A total of 69 individuals were randomly assigned to receive ESPB(n=34)or not receive ESPB(n=35).The AGI grade and gastrointestinal function score decreased in both group in the study.However,During the 3rd day study period,the AGI grade in the ESPB group was lower than in the NESPB group(2(1-2)vs 2(2-2),P=0.016),and the AGI score had fallen more in ESPB group(l(1-0)vs 0(1-0),P=0.006).Moreover,the dose of opioids in the ESPB group generally declined throughout the 7th day study period.During the 5th day study period,the dose of opioids in the ESPB group was lower than those in the NESPB group(253.72(0-461)vs 406.70(231-500),P=0.011).Mortality at 28th days was lower in the ESPB group than in the NESPB group(23.5%(8/34)vs48.6%(17/35),P=0.014).However,no difference in the terms of intra-abdominal pressure,the diameter of transverse colon,inflammatory factor,length of stay in ICU,cost of stay in ICU,length of stay in hospital and cost of stay in hospital was found between the two group.There were 6 cases(17%)of adverse event at the ESPB group,including 3 case(8%)of tube removal and 3 case(8%)of blood oozing at the puncture site.There was no serious adverse event in the study.ConclusionESPB not only can improve gastrointestinal function of critical care patients with AGI,but also reduce the dose of opioids and improve the prognosis. |
PDF Full Text Request