Abstract: Objective　To investigate the effect of paravertebral nerve block combined with general anesthesia on postoperative recovery quality and analgesia in patients with middle and lower thoracic esophageal cancer. Methods　According to the random number table method, 86 patients with middle and lower thoracic esophageal cancer admitted to Zaozhuang Chest Hospital from February 2020 to February 2021 were divided into a control group and an experimental group, with 48 cases in each group. The control group had 31 males and 12 females who were (54.18±6.26) years old, and received general anesthesia. The experimental group had 33 males and 10 females who were (55.18±7.26) years old, and received paravertebral nerve block combined with systemic anesthesia. Both groups were observed until 48 hours after the surgery. The postoperative recovery-related indicators, the Quality of Recovery-40 (QoR-40) scores 24 h after surgery, the scores of Ricker Sedation-Agitation Scale (SAS) and Visual Analogue Scale (VAS) 4, 24, and 48 h after the surgery, and incidences of postoperative adverse reactions were compared between the two groups. The measurement data were expressed as (x±s), and were tested by t test. The count data were expressed as [cases (%)], and were tested by χ² test. Results　The times for complete recovery of spontaneous breathing, calling and opening eyes, extubation, and orientation recovery were (3.42±0.74) min, (7.92±1.33) min, (6.92±1.25) min, and (11.15±1.24) min in the experimental group, and were (5.76±0.71) min, (11.33±1.52) min, (14.94±1.83) min, and (23.63±3.27) min in the control group (t=14.962, 11.071, 25.730, and 23.401; all P<0.05). Twenty-four hours after the operation, the QoR-40 scores of the experimental group were higher than those of the control group (all P<0.05). Four, twenty-four, and forty-eight h after the operation, the scores of SAS and VAS decreased in the two groups, and were lower in the experimental group than in the control group (all P<0.05). The incidence of postoperative adverse reactions was 20.93% (9/43) in the control group, and was 9.30% (4/43) in the observation group, with no statistical difference between the groups (P>0.05). Conclusion　Paravertebral nerve block combined with general anesthesia for patients taking middle and lower thoracic esophageal cancer surgery can effectively shorten the postoperative recovery time, reduce pain, and improve postoperative recovery quality.

Key words: Esophageal cancer, General anesthesia, Paravertebral nerve block, Recovery quality, Analgesic effect

摘要： 目的　探讨椎旁神经阻滞复合全身麻醉对胸中下段食管癌患者术后苏醒质量及镇痛效果的影响。方法　按随机数字表法将枣庄市胸科医院2020年2月至2021年2月收治的86例胸中下段食管癌患者分入对照组与试验组（每组43例）。对照组男31例，女12例，年龄（54.18±6.26）岁，予以全身麻醉。试验组男33例，女10例，年龄（55.18±7.26）岁，予以椎旁神经阻滞复合全身麻醉，两组均观察至术后48 h。比较两组术后苏醒相关指标、术后24 h的恢复质量评分量表（Quality of Recovery-40，QoR-40）各项评分、术后4 h、24 h、48 h的Ricker镇静-躁动评分（Ricker Sedation-Agitation Scale，SAS）、视觉模拟量表（Visual Analogue Scale，VAS）评分及术后不良反应发生情况。计量资料以（x±s）表示，并行t检验，计数资料以率（%）表示，并行χ²检验。结果　试验组自主呼吸完全恢复时间、呼唤睁眼时间、拔管时间、定向力恢复时间分别为（3.42±0.74）min、（7.92±1.33）min、（6.92±1.25）min、（11.15±1.24）min，均短于对照组的（5.76±0.71）min、（11.33±1.52）min、（14.94±1.83）min、（23.63±3.27）min（t=14.962、11.071、25.730、23.401，均P<0.05）。术后24 h，试验组QoR-40各项评分高于对照组（均P<0.05）；术后4～48 h两组SAS、VAS评分呈逐渐降低趋势，试验组低于对照组（P<0.05）。对照组术后不良反应发生率为20.93%（9/43），观察组术后不良反应发生率为9.30%（4/43），组间比较差异无统计学意义（P>0.05）。结论　在胸中下段食管癌手术患者中，应用椎旁神经阻滞复合全身麻醉可有效缩短术后恢复时间，减轻疼痛，改善术后苏醒质量。

关键词: 食管癌, 全身麻醉, 椎旁神经阻滞, 苏醒质量, 镇痛效果