腹横肌平面阻滞超前镇痛对消化道肿瘤根治术老年患者术后疼痛和认知功能的影响  

Effects of transversus abdominis plane block on postoperative cognitivedysfunction in elderly patients undergoing gastrointestinal cancerradical surgery

作　　者：杨波[1] 和荣丽[1] 贺兴义[2] 谢志伟[2] 李志霞[2] 

机构地区：[1]山西医科大学人体解剖学教研室,山西太原030001 [2]大同市第三人民医院麻醉科,山西大同037001

出　　处：《当代医学》2017年第27期38-42,共5页Contemporary Medicine

摘　　要：目的探讨腹横肌平面阻滞(TAP)超前镇痛对消化道肿瘤根治术老年患者术后疼痛和认知功能的影响。方法选择全麻下拟行择期消化道肿瘤根治术的老年患者60例,采用随机数字表法,将其随机分为TAP组(T组)和对照组(C组),每组30例。T组于麻醉诱导完成后在超声引导下行双侧TAP阻滞,其中拟行胃癌根治术者选择肋缘下入路阻滞,拟行结、直肠癌根治术者选择腋前线入路阻滞,针尖达到TAP内回抽无血后注入0.5%的罗哌卡因15 m L,C组注射等容量生理盐水,两组术后均接患者自控静脉镇痛(PCIA)泵(配方相同)。观察并记录麻醉诱导前、切皮即刻、拔管前5 min、拔管后30 min的MAP、HR和SpO_2。记录手术时间、术中失血量、补液量以及瑞芬太尼和丙泊酚的用量。分别于麻醉诱导前及术后6、12、24 h抽取静脉血,采用酶联免疫吸附双抗体夹心法检测S-100β蛋白的浓度。应用简易精神状态量表(MMSE)评估患者术前1 d及术后1 d、2 d、3 d的认知功能,采用视觉模拟评分(VAS)评估患者疼痛程度。结果与C组比较,T组瑞芬太尼用量减少(P<0.05),T组在切皮即刻、拔管前5 min和拔管后30 min的MAP和HR降低(P<0.05),T组在术后6 h、12 h和24 h的S-100β蛋白浓度减少(P<0.05),T组在术后1 d、和2 d的MMSE评分增加(P<0.05),在术后1 d、2 d和3 d的VAS评分降低(P<0.05)。结论 TAP阻滞超前镇痛能提供良好的镇痛,改善行消化道肿瘤根治术老年患者的术后认知功能障碍。Objective To investigate the effects of transversus abdominis plane block on postoperative cognitive dysfunction in elderly patients undergoing gastrointestinal cancerradical surgery.Methods Sixtyelderlypatientsscheduled for gastrointestinal cancer radicalsurgery were randomLydivided into transversus abdominis plane block group（Group T） and control group（Group C）.In group T,0.5% ropivacaine15 m Lwas administered into transversus abdominis planeunder the guidance of ultrasoundwhilethe same volume normal saline was administered in group C.The subcostal incisionapproach was adopted in patientsundergoingradical gastrectomy while the anterior axillary lineapproach was adopted in patients undergoingcolorectal cancer radical surgery.Both groups were connected with PCIA after operation.Mean arterial pressure,heart rate and saturation of pulse oxygen were observed and recorded at the time befor anesthesia induction,skin incision,5 minutes before extubation and 30 minutes after extubation.Theduration time of operation,the volume of blood loss and fluid input,consumption of remifentanil and propofol were recorded.Concentrations of serum protein S-100βwere assayed before anesthesiainduction,6h,12 h,and 24 h after operation.Cognitive function and pain degree was respectively assessed by Minimal Mental State Examination（MMSE） and visual analogue scaleat1 d before operation,1d,2d and 3d after operation.Results Compared with group C,the consumption of remifentanil was reduced（p〈0.05）,MAP and HR was decreased at time ofskin incision,5 minutes before extubation and 30 minutes after extubation（p〈0.05）,concentrations of serum protein S-100β was reducedat 6h,12 h,and 24 h after operation（p〈0.05）,MMSE score was increased at 1d,2d after operation（p〈0.05）,VAS score was decreased at 1d,2d and 3d after operation in group T（p〈0.05）.Conclusion Transversus abdominis plane block preemptive analgesia could provide effective postoperative analgesia,and improve postoperative cognitive dysfunctioninelde

关 键 词：腹横肌平面阻滞 超前镇痛 肿瘤 认知功能 老年患者 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]