联合胸神经阻滞应用于老年胸腔镜肺叶切除术后的效果及对认知功能的影响  

Effect of Combined Thoracic Nerve Block on Cognitive Function After Thoracoscopic Lobectomy in Elderly Patients

作　　者：袁志国[1] 朱玫[1] 魏晓佳 姜琳[1] 孙灿林[1] YUAN Zhi-guo;ZHU Mei;WEI Xiao-jia;JIANG Lin;SUN Can-lin(Department of Anesthesiology,Taizhou People's Hospital,Taizhou 225300,Jiangsu,China)

机构地区：[1]泰州市人民医院麻醉科,江苏泰州225300

出　　处：《医学信息》2022年第11期102-105,共4页Journal of Medical Information

基　　金：泰州市人民医院院级课(编号:ZD202025)。

摘　　要：目的探讨老年胸腔镜肺叶切除术(TL)联合应用胸神经阻滞的效果及对认知功能的影响。方法选择2021年3月-8月泰州市人民医院收治的60例肺部肿瘤患者,按照随机数字表法分为试验组(30例)和参照组(30例)。参照组实施前锯肌阻滞,试验组在此基础上联合胸神经阻滞。比较术后6 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)患者的简易视觉模拟疼痛评分(VAS)、Loewenstein认知功能评估量表(LOTCA)评分、美国匹兹堡睡眠质量指数量表(PSQI)评分及不良反应发生率;T0、T1、T2时两组血管内皮素-1(ET-1)、心输出量(Cor)水平。结果T1、T2、T3、T4时,试验组VAS评分、LOTCA评分、PSQI评分、不良反应发生率均低于参照组,差异有统计学意义(P<0.05);T1、T2时试验组ET-1、Cor均低于参照组,差异有统计学意义(P<0.05)。结论老年TL联合应用胸神经阻滞镇痛效果理想,可减轻认知功能损伤,降低机体应激反应,优化患者睡眠质量,且术后不良反应发生风险较低,安全性高。Objective To investigate the effect of thoracoscopic lobectomy(TL)combined with thoracic nerve block on cognitive function in elderly patients.Methods Sixty patients with pulmonary tumors admitted to Taizhou People's Hospital from March to August 2021 were randomly divided into experimental group(30 cases)and reference group(30 cases).The reference group was treated with anterior serratus block,and the experimental group was treated with thoracic nerve block on the basis of the reference group.The Visual Analogue Scale(VAS),Loewenstein Cognitive Assessment(LOTCA)score,Pittsburgh Sleep Quality Index(PSQI)score and incidence of adverse reactions were compared at 6 h(T1),12 h(T2),24 h(T3)and 48 h(T4)after surgery.The levels of endothelin-1(ET-1)and cardiac output(Cor)in the two groups at T0,T1 and T2.Results At T1,T2,T3 and T4,the VAS score,LOTCA score,PSQI score and incidence of adverse reactions in the experimental group were lower than those in the reference group,and the differences were statistically significant(P<0.05).At T1 and T2,ET-1 and Cor in the experimental group were lower than those in the reference group,and the difference was statistically significant(P<0.05).Conclusion TL combined with thoracic nerve block in the elderly has ideal analgesic effect,which can reduce cognitive impairment,reduce the body's stress response,optimize the sleep quality of patients,and has a low risk of postoperative adverse reactions and high safety.

关 键 词：肺部肿瘤 老年胸腔镜肺叶切除术 胸神经阻滞 认知功能 镇痛效果 

分 类 号：R592[医药卫生—老年医学] R971.2[医药卫生—内科学]