右美托咪定复合胸椎旁神经阻滞对老年患者胸腔镜肺叶切除术后认知功能障碍的影响  

Effect of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block on Cognitive Dysfunction after Thoracoscopic Lobectomy in Elderly Patients

作　　者：黄飞彬 吴集灵 HUANG Feibin;WU Jiling(Zhangzhou Municipal Hospital,Zhangzhou 363000,China)

机构地区：[1]漳州市医院,福建漳州363000

出　　处：《中外医学研究》2022年第26期5-8,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨右美托咪定复合胸椎旁神经阻滞(TPVB)对老年患者胸腔镜肺叶切除术后认知功能障碍的影响。方法:选取2021年6月-2022年1月在漳州市医院行胸腔镜肺叶切除术老年患者100例,随机分为对照组(n=50)和观察组(n=50);麻醉诱导前,两组均于超声引导下行TPVB,对照组注入0.375%罗哌卡因20 ml,观察组注入0.375%罗哌卡因20 ml+右美托咪定0.8 μg/kg;两组均采取相同的麻醉诱导和麻醉维持方案,术后均予以自控静脉镇痛。记录两组镇痛药物使用情况;于术前1 d及术后1、3、7 d评估两组简易智力状态量表(MMSE)评分,并统计术后7 d内两组术后认知功能障碍(POCD)发生情况;于术前1 d及术后1 d行血清神经元特异性烯醇化酶(NSE)、S100β蛋白水平的测定。结果:观察组丙泊酚、舒芬太尼及瑞芬太尼的消耗量均少于对照组,术后补救镇痛率低于对照组,差异均有统计学意义(P<0.05)。术后1、3 d,观察组MMSE评分显著高于对照组(P<0.05);术后7 d内观察组POCD发生率为6.00%,显著低于对照组的22.00%(P<0.05)。术后1 d,两组S100β蛋白和NSE水平均升高(P<0.05),但观察组S100β蛋白和NSE水平低于对照组(P<0.05)。结论:右美托咪定复合胸椎旁神经阻滞TPVB可改善老年患者胸腔镜肺叶切除术后认知功能,减少POCD发生。Objective:To investigate the effect of Dexmedetomidine combined with thoracic paravertebral nerve block (TPVB) on cognitive dysfunction after thoracoscopic lobectomy in the elderly patients.Method:A total of 100 elderly patients with thoracoscopic lobectomy in Zhangzhou Municipal Hospital from June 2021 to January 2022 were selected and randomly divided into control group (n=50) and observation group (n=50).Before anesthesia induction,TPVB was performed under ultrasound guidance in both groups,20 ml of 0.375% Ropivacaine was injected into the control group and 20 ml of 0.375% Ropivacaine+0.8 μg/kg Dexmedetomidine was injected into the observation group.Both groups adopted the same anesthesia induction and anesthesia maintenance scheme,and the patients were given patient-controlled intravenous analgesia after operation.The use of analgesic drugs in the two groups was recorded.The mini-mental state examination (MMSE) scores in the two groups were evaluated on the 1 day before operation and the 1,3 and 7 days after operation,and the occurrence of postoperative cognitive dysfunction (POCD) in the two groups within the 7 days after operation was counted.Serum neuron specific enolase (NSE) and S100β protein levels were measured at 1 day before operation and 1 day after operation.Result:The consumption of Propofol,Sufentanil and Remifentanil in the observation group were lower than those in the control group,and the postoperative rescue analgesia rate was lower than that in the control group,the differences were statistical significance (P<0.05).At 1 and 3 days after operation,the MMSE score in the observation group were significantly higher than those in the control group (P<0.05).The incidence of POCD in the observation group was 6.00% within 7 days after operation,which was significantly lower than 22.00% in the control group (P<0.05).At 1 day after operation,the levels of S100β protein and NSE in the two groups were increased (P<0.05),but the levels of S100β protein and NSE in the observation group were lower th

关 键 词：胸腔镜 肺叶切除术 神经传导阻滞 胸椎旁 右美托咪定 认知功能 

分 类 号：R614[医药卫生—麻醉学]