腹横肌平面阻滞对全麻腹腔镜手术老年患者术后认知功能的影响  

Effect of transversus abdominis plane block on postoperative cognitive function in elderly patients undergoing laparoscopic surgery under general anesthesia

作　　者：曹寅 徐静静 余秀国 郑燕娜 赵静波 陈益君[4] 黄自生[4] 黄长顺[4] Cao Yin;Xu Jingjing;Yu Xiuguo;Zheng Yanna;Zhao Jingbo;Chen Yijun;Huang Zisheng;Huang Changshun(Department of Anesthesiology,Ningbo Ninth Hospital,Ningbo 315000,China;Department of General Surgery,Ningbo Ninth Hospital,Ningbo 315000,China;Department of Operating Room,Ningbo Ninth Hospital,Ningbo 315000,China;Department of Anesthesiology,Ningbo First Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第九医院麻醉科,315000 [2]宁波市第九医院普外科,315000 [3]宁波市第九医院手术室,315000 [4]宁波市第一医院麻醉科,315000

出　　处：《中华麻醉学杂志》2019年第2期139-142,共4页Chinese Journal of Anesthesiology

基　　金：宁波市医学科技计划项目(2017A24).

摘　　要：目的评价腹横肌平面阻滞对全麻腹腔镜手术老年患者术后认知功能的影响。方法择期全麻下行腹腔镜腹股沟斜疝无张力修补术男性患者48例,年龄65~75岁,ASA分级Ⅱ或Ⅲ级,BMI 20~28 kg/m^2。采用随机数字法分为2组(n=24):腹横肌平面阻滞联合全麻组(TG组)和全麻组(G组)。静脉注射咪达唑仑、顺苯磺酸阿曲库铵、舒芬太尼和依托咪酯麻醉诱导,置入喉罩后行机械通气。采用髂前上棘入路行腹横肌平面阻滞,TG组注射0.25%罗哌卡因30ml。靶控输注丙泊酚和瑞芬太尼维持麻醉,静脉注射顺苯磺酸阿曲库铵维持肌松。分别于麻醉诱导前1min(T0)、置入喉罩后5min(T1)、切皮即刻(T2)、切皮后30 min(T3)和术毕即刻(T4)记录脑氧饱和度(rSO2)及低rSO2事件(rSO2<60%)发生情况。记录术中丙泊酚和瑞芬太尼用量。分别于术前1 d和术后7 d时,采用蒙特利尔认知功能评估量表(MoCA)评估患者认知功能,记录术后认知功能障碍(POCD,MoCA评分<26分)发生情况。结果与G组比较,TG组术中丙泊酚和瑞芬太尼用量减少,T2-4时rSO2升高,低rSO2事件发生率降低,术后7 d时MoCA评分升高,POCD发生率降低(P<0.05)。结论腹横肌平面阻滞可降低全麻腹腔镜手术老年患者POCD的发生。Objective To evaluate the effect of transversus abdominis plane(TAP)block on postoperative cognitive function in elderly patients undergoing laparoscopic surgery under general anesthesia.Methods Forty-eight male patients undergoing laparoscopic tension-free repair of inguinal hernia under general anesthesia,aged 65-75 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,with body mass index of 20-28 kg/m^2,were divided into 2 groups(n=24 each)using a random number table method:TAP block combined with general anesthesia group(group TG)and general anesthesia group(group G).Anesthesia was induced with midazolam,cisatracurium besylate,sufentanil and etomidate,and the patients were mechanically ventilated after laryngeal mask airway insertion.TAP block was performed through the anterior superior iliac spine approach,and 0.25%ropivacaine 30 ml was injected in group TG.Anesthesia was maintained by target-controlled infusion of propofol and remifentanil and muscle relaxation by intravenously injecting cisatracurium.The occurrence of cerebral regional oxygen saturation(rSO2)and low rSO2 events(rSO2<60%)was recorded at 1 min before anesthesia induction(T0),5 min after inserting the laryngeal mask airway(T1),at skin incision(T2),30 min after skin incision(T3),and at the end of surgery(T4).The consumption of propofol and remifentanil was recorded during surgery.Montreal Cognitive Assessment(MoCA)was used to evaluate the cognitive function of patients at 1 day before surgery and 7 days after surgery,and the development of postoperative cognitive dysfunction(POCD,MoCA scores<26)was recorded.Results Compared with group G,the intraoperative consumption of propofol and remifentanil was significantly reduced,rSO2 was increased at T2-4,and the incidence of low rSO2 events was decreased,MoCA scores were increased at 7 days after surgery,and the incidence of POCD was decreased in group TG(P<0.05).Conclusion TAP block can reduce the incidence of POCD in elderly patients undergoing laparoscopic surgery under general anes

关 键 词：神经传导阻滞 腹肌 麻醉 全身 老年人 腹腔镜检查 认知障碍 

分 类 号：R614[医药卫生—麻醉学]