超声引导下胸椎旁神经阻滞复合全身麻醉对老年肺癌患者认知功能、肿瘤标志物和炎性反应的影响  

Effect of Ultrasound-guided Parathoracic Nerve Block Combined with General Anesthesia on Cognitive Function,Tumor Markers and Inflammatory Response in Elderly Patients with Lung Cancer

作　　者：王竹[1] 黄伯万 杨柳[1] 潘秋宁 梁艳丽[1] 于品仙 林丽娟[1] WANG Zhu;HUANG Bowan;YANG Liu;PAN Qiuning;LIANG Yanli;YU Pinxian;LIN Lijuan(Zhanjiang Central People’s Hospital,Zhanjiang 524037,China;不详)

机构地区：[1]广东省湛江中心人民医院,广东湛江524037

出　　处：《中国医学创新》2021年第2期141-145,共5页Medical Innovation of China

基　　金：湛江市非资助科技攻关计划项目(2019B01040)。

摘　　要：目的:探讨超声引导下胸椎旁神经阻滞复合全身麻醉在老年肺癌根治术患者中应用对认知功能、肿瘤标志物、炎性反应和术后恢复情况的影响。方法:回顾性分析2018年3月-2019年9月于本院因非小细胞肺癌需手术治疗的68例老年患者的临床资料,按照不同麻醉方法将其分为观察组和对照组,各34例。观察组予以超声引导下胸椎旁神经阻滞复合全身麻醉,对照组予以全身麻醉。比较两组手术前后认知功能、肿瘤标志物、炎性因子和术后恢复指标以及术后2、12、24、48 h的疼痛视觉模拟评分(VAS)。结果:术后24 h,观察组MMSE评分高于对照组,IL-6、IL-10、TNF-α、CYFRA21-1、CA125、CA199和CEA水平均低于对照组,差异均有统计学意义(P<0.05)。观察组术后2、12、24、48 h的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组苏醒室停留时间、拔管时间、下床活动时间和住院时间均较对照组短,恶心呕吐例数较对照组少,差异均有统计学意义(P<0.05)。手术开始后2 h,观察组的收缩压、舒张压和心率均低于对照组,差异均有统计学意义(P<0.05)。结论:超声引导下胸椎旁神经阻滞复合全身麻醉在老年肺癌患者中应用可有效减轻疼痛,改善认知功能,降低肿瘤标志物水平,减轻炎症反应,促进康复,缩短住院时间,值得临床推广应用。Objective:To investigate the application of ultrasound-guided paravertebral nerve block combined general anesthesia on cognitive function,tumor markers,inflammatory response and postoperative recovery in elderly patients with lung cancer radical surgery.Method:The clinical data of 68 elderly patients with non-small cell lung cancer requiring surgical treatment in our hospital from March 2018 to September 2019 were retrospectively analyzed,according to different anesthesia methods,they were divided into observation group and control group,34 cases in each group.The observation group was given ultrasound-guided parathoracic nerve block combined with general anesthesia,while the control group was given general anesthesia.The cognitive function,tumor markers,inflammatory factors and postoperative recovery indicators before and after surgery,as well as the pain visual analogue scale(VAS)at 2,12,24,48 h after surgery were compared between the two groups.Result:24 h after the operation,MMSE level of the observation group was higher than that of the control group,the levels of IL-6,IL-10,TNF-α,CYFRA21-1,CA125,CA199 and CEA were lower than those of the control group,with statistically significant differences(P<0.05).VAS scores of the observation group at 2,12,24,48 h after operation were all lower than those of the control group,with statistically significant differences(P<0.05).In the observation group,the stay time in the waking room,extubation time,activity time out of bed and hospitalization time were shorter than those in the control group,the number of cases of nausea and vomiting was less than that in the control group,with statistically significant differences(P<0.05).2 h after the operation,the systolic blood pressure,diastolic blood pressure and heart rate in the observation group were all lower than those in the control group,with statistically significant differences(P<0.05).Conclusion:Ultrasound-guided parathoracic nerve block combined with general anesthesia can effectively reduce pain,improve cognitive fun

关 键 词：超声引导下胸椎旁神经阻滞 全身麻醉 肺癌 老年患者 认知功能 肿瘤标志物 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]