胸椎旁神经阻滞联合全身麻醉对胸腔镜肺癌根治术老年患者术后脑损伤的影响  

Effect of thoracic paravertebral block combined with general anesthesia on postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer

作　　者：周据津 李陈茜 李冰 张璐瑶 张加强 张伟 Zhou Jujin;Li Chenqian;Li Bing;Zhang Luyao;Zhang Jiaqiang;Zhang Wei(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People′s Hospital(People′s Hospital of Zhengzhou University),Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2022年第1期34-38,共5页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190607,LHGJ20200059)。

摘　　要：目的评价胸椎旁神经阻滞联合全身麻醉对胸腔镜肺癌根治术老年患者术后脑损伤的影响。方法择期行胸腔镜下肺癌根治术患者100例,年龄≥65岁,BMI 20~24 kg/m^(2),性别不限,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=50):全身麻醉组(G组)和胸椎旁神经阻滞联合全身麻醉组(TG组)。TG组在麻醉诱导前行胸椎旁神经阻滞。2组患者均静脉注射咪达唑仑、依托咪酯、罗库溴铵和舒芬太尼进行麻醉诱导,术中靶控输注丙泊酚和瑞芬太尼维持麻醉,间断静脉注射顺式阿曲库铵维持肌松,术毕连接镇痛泵行PCIA。于入室后5 min(T_(1))、术后24 h(T_(2))及72 h(T_(3))时检测血浆S100β、NSE、Tau蛋白、β淀粉样蛋白及IL-6的浓度;于术前1 d(T_(0))、T_(2)及T_(3)时采用简易精神状态检查量表和蒙特利尔认知评估量表评估认知功能,记录认知功能障碍发生情况;采用数字评定量表评估患者术前1 d、手术当日和术后第3天的夜间睡眠质量;记录术后72 h内恶心呕吐发生情况、围术期舒芬太尼用量、术后24 h内镇痛泵有效按压次数及补救镇痛情况。结果2组患者术后均未见恶心呕吐发生,均未使用补救镇痛。与G组比较,TG组T_(2)时血浆S100β、NSE及IL-6浓度、蒙特利尔认知评估量表评分、认知功能障碍发生率降低,睡眠质量评分升高,围术期舒芬太尼使用量、镇痛泵有效按压次数减少(P<0.05),血浆Tau蛋白、β淀粉样蛋白浓度差异无统计学意义(P>0.05)。结论胸椎旁神经阻滞联合全身麻醉有助于减轻胸腔镜下肺癌根治术老年患者术后脑损伤。Objective To evaluate the effect of thoracic paravertebral block(TPVB)combined with general anesthesia on the postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 100 patients of either sex,aged≥65 yr,with body mass index of 20-24 kg/m^(2),of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective thoracoscopic radical resection of lung cancer,were divided into 2 groups(n=50 each)by using a random number table method:general anesthesia group(G group)and TPVB combined with general anesthesia group(TG group).TPVB was performed before induction of anesthesia in group TG.Anesthesia was induced with IV midazolam,etomidate,rocuronium and sufentanil and maintained with infusion of propofol and remifentanil and intermittent IV boluses of cis-atracurium.Patient-controlled intravenous analgesia(PCIA)was used for postoperative analgesia after surgery.Venous blood samples were taken at 5 min after entering the operating room and 24 and 72 h after surgery to determine the concentrations of S100β,neuron-specific enolase,Tau protein,βamyloid and interleukin-6 in plasma.The cognitive function was assessed by using the Mini Mental State Examination Scale and Montreal Cognitive Assessment Scale at 1 day before surgery and 24 and 72 h after surgery,and cognitive dysfunction was recorded.The quality of night sleep was assessed using Numerical Rating Scale at 1 day before surgery,on the day of surgery and on day 3 after surgery.The occurrence of nausea and vomiting within 72 h after operation,perioperative consumption of sufentanil,effective pressing times of PCA within 24 h after operation and requirement for postoperative rescue analgesia were recorded.Results No postoperative nausea and vomiting was found and no patients required rescue analgesia in either group.Compared with group G,the concentrations of S100β,neuron-specific enolase and interleukin-6 in plasma,Montreal Cognitive Assessment scale score,and incidence of cogniti

关 键 词：神经传导阻滞 胸椎 肺肿瘤 老年人 脑损伤 

分 类 号：R614[医药卫生—麻醉学]