硬膜外阻滞对全麻下腹腔镜胃癌根治术老年病人术后认知功能障碍的影响  

Effect of epidural block on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia

作　　者：蒋宗明[1] 丛昊[1] 仲俊峰[1] 周其富[1] 郑羡河[1] 李玉红[1] 陈忠华[1] 

机构地区：[1]312000绍兴市人民医院浙江大学绍兴医院麻醉科

出　　处：《中华麻醉学杂志》2013年第9期1056-1058,共3页Chinese Journal of Anesthesiology

基　　金：浙江省医学会临床科研资金项目（2011ZYC-A89）

摘　　要：目的 评价硬膜外阻滞对全麻下腹腔镜胃癌术后老年病人认知功能障碍的影响.方法 择期腹腔镜胃癌根治术老年病人60例,年龄65 ～ 75岁,ASA分级Ⅰ或Ⅱ级,术前简易智能状态量表（MMSE）评分＞23分.采用随机数字表法将其分为硬膜外阻滞组（E组）和对照组（C组）,每组30例.麻醉诱导前行硬膜外穿刺置管术.麻醉诱导：静脉注射咪达唑仑0.03 mg/kg、丙泊酚1.0～1.5mg/kg、芬太尼3～ 4μg/kg、罗库溴铵0.9 mg/kg,气管插管术后行机械通气.麻醉维持：静脉输注瑞芬太尼0.15～0.25 μg·kg-1 ·main-1及靶控输注丙泊酚（血浆靶浓度2.5 ～ 3.0 μg/ml）.E组切皮前30 min时硬膜外腔注射0.25％罗哌卡因＋0.04 mg/ml布托啡诺混合液10 ml,2组均在手术结束前10 min硬膜外注射以上混合液10 ml,随后行病人自控硬膜外镇痛.记录术后72 h内认知功能障碍（MMSE评分＜21分）的发生情况.于麻醉诱导前、术后6、12和24 h时采集颈内静脉血样,测定血清S-100β蛋白浓度.结果 与C组比较,E组术后6、12和24h时血清S-100β蛋白降低,术后认知功能障碍发生率降低（P＜0.05）.结论 硬膜外阻滞可降低全麻下腹腔镜胃癌根治术老年患者术后认知功能障碍的发生.Objective To evaluate the effect of epidural block on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 65-75 yr,with preoperative Mini-Mental State Examination （MMSE） score 〉 23,scheduled for elective laparoscopic radical operation for gastric cancer under general anesthesia,were randomized into epidural block group （group E,n =30） and control group （group C,n =30） using a random number table.Epidural block was performed at T8,9 interspace before induction of anesthesia.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg,propofol 1.0-1.5 mg/kg,fentanyl 3-4 μg/kg and rocuronium 0.9 mg/kg.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of remifentanil 0.15-0.25 μg· kg-1· min 1 and propofol target-controlled infusion （target plasma concentration 2.5-3.0μg/ml）.In group E,10 ml of mixture of 0.25% ropivacaine and 0.04 mg/ml butorphanol was injected via the epidural catheter at 30 min before skin incision.In the two groups,the mixture 10 ml mentioned above was administered via the epidural catheter at 10 min before the end of operation followed by patientcontrolled epidural analgesia.The development of postoperative cognitive dysfunction （MMSE score 〈 21） was recorded within 72 h after operation.Blood samples were collected from the internal jugular vein to detect the concentration of serum protein S-100β.Results The concentration of serum protein S-100β was significantly lower at 6,12 and 24 h after operation,and the incidence of postoperative cognitive dysfunction within 72 h after operation was lower in group E than in group C （P 〈 0.05）.Conclusion Epidural block can decrease the development of postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia. Keywords：Anesthe

关 键 词：麻醉 硬膜外 麻醉 全身 手术后并发症 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学]