胸椎旁神经阻滞联合静吸复合全麻对老年腹腔镜胆囊切除术患者术后镇痛及认知功能的影响  

The effect of thoracic paravertebral block combined with intravenous and inhalation general anesthesia on postoperative analgesia and cognitive function in elderly patients undergoing laparoscopic cholecystectomy

作　　者：瞿琬林[1] 陈峰[1] 聂曾波 古玲玲[1] QU Wan-lin;CHEN Feng;NIE Zeng-bo;GU Ling-ling(Anesthetic Surgery Center,Dujiangyan People's Hospital,Chengdu 611830,China;Qingchengshan Township Central Hospital of Dujiangyan,Chengdu 611844,China)

机构地区：[1]四川省都江堰市人民医院麻醉手术中心,四川都江堰611830 [2]四川省都江堰市青城山镇中心卫生院,四川都江堰611844

出　　处：《实用医院临床杂志》2024年第5期177-180,共4页Practical Journal of Clinical Medicine

基　　金：成都市卫健委医学科研课题(编号:2022647)。

摘　　要：目的观察胸椎旁神经阻滞(TPVB)联合静吸复合全麻对老年患者腹腔镜胆囊切除术(LC)的术后镇痛效果及认知功能的影响。方法选取我院择期LC老年患者58例,按随机数字表法分为联合组和全麻组,全麻组(n=29)给予静吸复合全麻,联合组(n=29)给予TPVB联合静吸复合全麻。比较两组苏醒质量、术后48 h内补救镇痛情况、术后24 h内疼痛评分、术后3 d内认知功能恢复情况。结果联合组苏醒质量高于全麻组(P<0.05),术后患者静脉自控镇痛(PCIA)有效按压次数显著低于全麻组(P<0.05),两组患者补救镇痛率无显著性差异(P>0.05),术后24 h内VAS评分均显著低于全麻组(P<0.05),术后1 d认知功能发生率明显低于全麻组(P<0.05)。结论老年LC患者行TPVB联合静吸复合全麻有利于提高患者苏醒质量,辅助术后镇痛,患者认知功能恢复快,值得推荐。Objective To explore the effect of thoracic paravertebral block(TPVB)combined with intravenous and inhalation general anesthesia on postoperative analgesia and cognitive function in elderly patients undergoing laparoscopic cholecystectomy(LC).Methods Fifty-eight elderly patients underwent LC in our hospital were selected.The patients were divided into a combination group and a general anesthesia group by the random number table method,29 in each group.The general anesthesia group was given intravenous and inhalation general anesthesia.The combination group was given TPVB combined with intravenous and inhalation general anesthesia.The quality of recovery,remedial analgesia status within 48 h after surgery,pain score within 24 h after surgery,and cognitive function recovery within 3 days after surgery were compared between the two groups.Results The recovery quality in the combination group was higher than that in the general anesthesia group(P<0.05).The number of effective patient controlled intravenous analgesia(PCIA)compressions after surgery in the combination group was significantly less than that in the general anesthesia group(P<0.05).There was no significant difference in the rate of remedial analgesia after surgery(P>0.05).The VAS score in the combination group within 24 h after surgery was significantly lower compared to the general anesthesia group(P<0.05).The incidence of cognitive dysfunction 1 day after surgery in the combined group was significantly lower than that in the general anesthesia group(P<0.05).Conclusions TPVB combined with intravenous and inhalation general anesthesia in elderly LC patients can help to improve the recovery quality,and assist the postoperative analgesia.It also speeds up the recovery of cognitive function of the patients.It is worthy of recommendation.

关 键 词：神经阻滞 全身麻醉 补救镇痛 认知功能 

分 类 号：R614.2[医药卫生—麻醉学] R575.6[医药卫生—外科学]