摘要
目的评价竖脊肌平面(ESP)阻滞对老年患者胸腔镜肺癌根治术后早期认知功能的影响。方法择期行单孔胸腔镜下肺癌根治术老年患者60例,性别不限,年龄≥65岁,BMI<30 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=30):ESP阻滞+全麻组(ESP+GA组)和全麻组(GA组)。ESP+GA组于麻醉诱导前行超声引导ESP阻滞。神经阻滞20 min后采用针刺法判断神经阻滞成功后行麻醉诱导。采用丙泊酚+瑞芬太尼维持麻醉。术后行PCIA。于术前1 d、术后1、2和3 d取静脉血样,采用ELISA法测定血清S100β蛋白和神经元特异性烯醇化酶(NSE)浓度;于术前1 d及术后3、5、7 d时,采用简易智力状态量表(MMSE)评估患者早期认知功能,记录术后7 d内认知功能障碍的发生情况。记录术中丙泊酚、瑞芬太尼和舒芬太尼用量。记录ESP阻滞相关并发症发生情况。结果与GA组比较,ESP+GA组丙泊酚、瑞芬太尼和舒芬太尼用量减少,术后1和3 d时血清S100β蛋白浓度和MMSE评分降低,术后1、3和5 d时血清NSE浓度降低,认知功能障碍发生率降低(P<0.05)。ESP+GA组ESP阻滞均成功,且未见血管、神经损伤发生。结论ESP阻滞联合全麻可改善老年患者胸腔镜肺癌根治术后早期认知功能。
Objective To evaluate the effect of erector spinae plane(ESP)block combined with general anesthesia on early postoperative cognitive function in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods Sixty patients of both sexes,aged≥65 yr,with body mass index<30 kg/m^(2),of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for single-port thoracoscopic radical resection of lung cancer,were divided into 2 groups(n=30 each)using a random number table method:ESP block plus general anesthesia group(group ESP+GA)and general anesthesia group(group GA).Ultrasound-guided ESP was performed at T4 before induction of general anesthesia in group ESP+GA.The success of the nerve block was determined by pin-prick test at 20 min after nerve block,and then anesthesia was induced.Anesthesia was maintained with propofol plus remifentanil in the two groups.Patient-controlled intravenous analgesia was performed.Venous blood samples were collected at 1 day before operation and 1,2 and 3 days after operation for determination of plasma S100βprotein and neuron-specific enolase(NSE)concentrations by enzyme-linked immunosorbent assay.At 1 day before operation and 3,5,and 7 days after operation,the early cognitive function was assessed using the Mini-Mental State Examination(MMSE),and the occurrence of postoperative cognitive dysfunction within 7 days after operation was recorded.The intraoperative consumption of propofol,remifentanil and sufentanil was recorded.The occurrence of complications related to ESP block was recorded.Results Compared with group GA,the consumption of propofol,remifentanil,and sufentanil was significantly reduced,the serum S100βprotein concentration and Mini-Mental State Examination score were decreased at 1 and 3 days after operation,serum NSE concentrations were decreased at 1,3 and 5 days after operation,and the incidence of postoperative cognitive dysfunction was decreased in group ESP+GA(P<0.05).ESP block was successful,and no vascular and nerve damage was
作者
胡振华
吴敏
王鹏
刘胜群
Hu Zhenhua;Wu Min;Wang Peng;Liu Shengqun(Department of Anesthesiology and Perioperative Medicine,Henan Province People′s Hospital,Zhengzhou 450003,China;Department of Anesthesiology,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China;Department of Anesthesiology,the Second People′s Hospital of Nanyang,Nanyang 473000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2021年第3期266-269,共4页
Chinese Journal of Anesthesiology
