胸椎旁神经阻滞联合全身麻醉对肺癌根治术老年患者认知功能的影响  

The Impact of Thoracic Paravertebral Block Combined with General Anesthesia on Cognitive Function in Elderly Patients Undergoing Radical Resection of Lung Cancer

作　　者：杨丽 安晓雷[2] 张进 YANG Li;AN Xiaolei;ZHANG Jin(Deparment of Anesthesiosion,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou 221004,China;不详)

机构地区：[1]徐州医科大学附属徐州市立医院(徐州市第一人民医院)麻醉科,江苏徐州221004 [2]徐州市中心医院神经内科,江苏徐州221009

出　　处：《中国医学创新》2025年第10期19-23,共5页Medical Innovation of China

基　　金：2023年江苏省卫生健康委科研课题(Ym2023012);2023年度徐州市医药卫生面上项目(KC23160);徐州市重点研发项目-医药卫生面上项目(KC22175);徐州医科大学附属医院发展基金资助项目(XYFM202236)。

摘　　要：目的:探讨胸椎旁神经阻滞联合全身麻醉在肺癌根治术中对老年患者认知功能的影响。方法:前瞻性纳入2022年1月—2024年1月徐州医科大学附属徐州市立医院收治的接受肺癌根治术的老年患者共80例。患者随机分为联合麻醉组(胸椎旁神经阻滞联合全身麻醉)和单纯全麻组(单纯全身麻醉),每组40例。比较两组血浆基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、脂蛋白磷酸酶A2(lipoprotein-phospholipase A2,Lp-PLA2)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的水平,并使用简易智能量表测试(mini-mental state examination,MMSE)和事件相关电位p300评估两组认知功能。结果:两组术后1、7 d的MMP-9、Lp-PLA2、IL-6和TNF-α均较术前1 d升高,且联合麻醉组均低于单纯全麻组。与单纯全麻组相比,联合麻醉组术后7 d的P300潜伏期较短,P300波幅及MMSE评分均较高。结论:胸椎旁神经阻滞能有效减轻老年患者全身麻醉肺癌根治术后神经炎症反应,改善认知功能。Objective:To investigate the effect of thoracic paravertebral block combined with general anesthesia on cognitive function in elderly patients undergoing radical resection of lung cancer.Method:Prospectively enrolled 80 elderly patients who underwent radical resection of lung cancer at Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2022 to January 2024.Patients were randomly divided into combined anesthesia group(thoracic paravertebral block combined with general anesthesia)and simple general anesthesia group(simple general anesthesia),with 40 cases in each group.Plasma matrix metalloproteinase-9(MMP-9),lipoprotein-phospholipase A2(Lp-PLA2),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels were compared between the two groups,and mini-mental state examination(MMSE)and event-related potential p300 were used to evaluate cognitive function in both groups.Result:The levels of MMP-9,Lp-PLA2,IL-6 and TNF-αin both groups at 1 and 7 d after surgery were higher than those at 1 d before surgery,and those of the combined anesthesia group were lower than those in the general anesthesia group.Compared with the simple general anesthesia group,the P300 latency was shorter and the P300 amplitude and MMSE score were higher in the combined anesthesia group at 7 d after surgery.Conclusion:Thoracic paravertebral block can effectively reduce neuroinflammatory response and improve cognitive function in elderly patients after radical resection of lung cancer under general anesthesia.

关 键 词：胸椎旁神经阻滞 肺癌手术 术后认知功能障碍 神经保护 炎症因子 

分 类 号：R614[医药卫生—麻醉学]