| BackgroundAcute Gastrointestinal Injury(AGI)is one of the common complications of critically ill patients,which are often secondary to serious diseases such as severe infection,burn and shock.Clinical manifestations are stomach retention,gastrointestinal bleeding,intestinal paralysis,abdominal high pressure/abdominal compartment syndrome,etc.It has been reported that the incidence of acute gastrointestinal injury in severe patients is about 60%-70%.At present,there are many clinical methods for the treatment of gastrointestinal injury,such as gastrointestinal decompression,early enteral nutrition,improving gastrointestinal microcirculation,promoting gastrointestinal motility drugs,but the overall effect is little.In recent years,some researchers have found that gastrointestinal dysfunction can be improved by blocking the sympathetic nerve that innervates the gastrointestinal tract.Compared with traditional nerve block technique,ultrasonic visualization neural localization technique has advantages of simple operation and fewer complications,and is gradually emerging in clinic.The purpose of this study is to evaluate whether the ultrasound-guided gastrointestinal erectivemuscular-interstitial nerve block can improve gastrointestinal dysfunction,reduce mortality and improve prognosis in critically ill patients.Objective1.Main research objective:To evaluate whether ultrasound-guided T8 thoracic erector spinus plane nerve block(ESPB)improves gastrointestinal dysfunction,reduces AGI level and GIF score in critically ill patients;2.Secondary research objective:Evaluate whether ultrasound-guided ESPB therapy improves the nutritional status of critically ill patients;Evaluate whether ultrasoundguided ESPB therapy reduces the level of inflammatory markers in critically ill patients;To evaluate whether ultrasound-guided ESPB therapy reduces 28-day mortality and prolongs survival.MethodsThe subjects were selected from patients who met the inclusion criteria and were admitted to Intensive Care Unit(ICU)of Zhu Jiang Hospital of Southern Medical University from September 2019 to August 2021.They were divided into intervention group and control group by simple randomization and approximately 1:1.The patients in the intervention group received conventional treatment of erector spinal interstitial nerve block combined with gastrointestinal dysfunction,while the control group only received conventional treatment.Patients in the intervention group received catheterization in the erector spinal space under ultrasound on the day of inclusion.After completion of the operation,10ml ropivacaine with a concentration of 7.5mg/ml was given for block therapy for the first time,followed by 20ml/h of ropivacaine with a concentration of 3.75mg/ml,twice a day,for a total of 7 days.The observation time was day 0,1,3,5 and 7 after enrollment.Efficacy evaluation indexes included AGI level,GIF score,APACHE Ⅱ score and SOFA score,plasma inflammation index,plasma nutrition index,28-day fatality rate and survival time.ResultsA total of 100 AGI patients who met the diagnostic criteria were included and divided into the intervention group(n=51)and the control group(n=49)according to the principle of simple randomization by approximately 1:1.AGI level and GIF score of both groups showed a significant downward trend after treatment.From the third day of enrollment,AGI level of intervention group was better than control group,and P<0.05,there was a statistical difference between the two groups.The 28-day mortality rate in the intervention group was significantly lower than that in the control group during follow-up(P=0.016).There were no significant differences in APACHEII score,SOFA score,abdominal perfusion pressure,plasma inflammation index and plasma nutrition index between the two groups.Conclusionsultrasound-guided T8 thoracic erector spinus plane nerve block(ESPB)treatment can reduce AGI level and GIF score,reduce 28-day mortality and improve prognosis in critically ill patients. |
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