星状神经节阻滞对老年胃肠道恶性肿瘤根治术患者术后认知功能障碍的影响  

Effects of stellate ganglion block on postoperative cognitive dysfunction in elderly patients undergoing radical resection of gastrointestinal malignancy

作　　者：张转[1] 郁言龙 李虎 袁博 王莹 于乐洋 严诗婷 ZHANG Zhuan;YU Yanlong;LI Hu;YUAN Bo;WANG Ying;YU Leyang;YAN Shiting(Department of Anesthesiology,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225012;Graduate School of Dalian Medical University,Dalian,Liaoning,116000)

机构地区：[1]扬州大学附属医院麻醉科,江苏扬州225012 [2]大连医科大学研究生院,辽宁大连116000

出　　处：《实用临床医药杂志》2023年第3期107-111,116,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生健康委员会基金面上项目(H2018049);江苏省扬州市卫生和计划生育委员会基金医学重点人才培养项目(ZDRC201815)。

摘　　要：目的探讨星状神经节阻滞(SGB)对老年胃肠道恶性肿瘤根治术患者术后认知功能障碍(POCD)的影响。方法将50例老年胃肠道恶性肿瘤根治术患者随机分为SGB组和对照组,最终共40例患者完成研究,每组20例。2组患者均行全身麻醉复合硬膜外麻醉,且SGB组术前行SGB。分别于全身麻醉诱导前(t_(0))、气管插管后即刻(t_(1))、手术开始时(t_(2))、手术开始后1 h(t3)、手术开始后2 h(t_(4))、术毕时(t_(5))、拔管后即刻(t_(6))和进入麻醉恢复室(PACU)内30 min时(t7)观察2组患者心率(HR)、平均动脉压(MAP),并观察t_(0)、t3、t_(4)、t_(5)时点血清电解质和血糖水平。分别于术前24 h(T_(0))、术后24 h(T_(1))、术后72 h(T_(2))检测2组患者血浆白细胞介素(IL)-1、IL-6、IL-10、S100β蛋白水平,并分别于T_(0)、T_(1)、T_(2)、术后5 d(T_(3))、术后7 d(T_(4))采用简易精神状态量表(MMSE)评估2组患者认知功能。结果SGB组t7时点HR低于t_(0)、t_(1)、t_(6)时点,且SGB组t_(1)、t_(2)、t_(6)时点MAP、HR均低于对照组,差异有统计学意义(P<0.05)。SGB组患者各时点血清钾、钙、乳酸水平与对照组比较,差异无统计学意义(P>0.05);SGB组t_(4)、t_(5)时点血糖水平均低于对照组,差异有统计学意义(P<0.05)。SGB组T_(1)时点IL-6水平、T_(2)时点IL-1水平和T_(1)、T_(2)时点S100β蛋白水平均低于对照组,T_(2)时点IL-10水平高于对照组,差异有统计学意义(P<0.05)。T_(1)、T_(2)时点,SGB组MMSE评分高于对照组,POCD发生率低于对照组,差异有统计学意义(P<0.05)。结论SGB可改善老年胃肠道恶性肿瘤根治术患者术后认知功能,降低POCD发生率。Objective To investigate the effects of stellate ganglion block(SGB)on postoperative cognition dysfunction(POCD)in elderly patients undergoing radical resection for gastrointestinal malignancy.Methods Fifty patients undergoing radical resection of gastrointestinal tract malignant tumor were randomly divided into SGB group and control group,and 40 patients completed the study finally,with 20 cases in each group.All patients in two groups received general anesthesia combined with epidural anesthesia,and SGB group received SGB before surgery.Heart rate(HR)and mean arterial pressure(MAP)in two groups before general anesthesia induction(t_(0)),immediately after tracheal intubation(t_(1)),at the beginning of surgery(t_(2)),1 h after surgery(t_(3)),2 h after surgery(t_(4)),at the end of surgery(t_(5)),immediately after extubation(t_(6)),and at 30 min(t7)when entering the anesthesia recovery room(PACU)were observed.Changes of electrolytes and blood glucose were observed at t_(0),t_(3),t_(4)and t_(5).Plasma interleukin(IL)-1,IL-6,IL-10 and S100βconcentrations were recorded at 24 h before(T_(0)),24 h after surgery(T_(1))and 72 h after surgery(T_(3)).Cognitive function was assessed at T_(0),T_(1),T_(3),5 d after operation(T_(4))and 7 d after operation(T_(5))using the Mini-Mental State Examination(MMSE).Results HR at t7in the SGB group was lower than that at t_(0),t_(1)and t_(6),and MAP and HR at t_(1),t_(2)and t_(6)in the SGB group were lower than those in the control group(P<0.05).There were no significant differences in serum potassium,calcium and lactic acid levels between the SGB group and the control group at each time point(P>0.05).Blood glucose levels at t_(4)and t_(5)in the SGB group were lower than those in the control group,the differences were statistically significant(P<0.05).The levels of IL-6 at T_(1),IL-1 at T_(2)and S100βprotein at T_(1)and T_(2)in the SGB group were lower than those in the control group,while the level of IL-10 at T_(2)was higher than those in control group(P<0.05).At T_(1)and T_(2),the M

关 键 词：星状神经节阻滞 恶性肿瘤 胃肠道 认知功能 老年人 术后认知功能障碍 

分 类 号：R735[医药卫生—肿瘤] R459.9[医药卫生—临床医学]