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胸椎旁神经阻滞复合全身麻醉对老年肺癌根治术患者的效果观察

Effect of thoracic paravertebral block combined with general anesthesia in radical operation of elderly patients with lung cancer

    摘要
  • 摘要:
    目的  观察胸椎旁神经阻滞(TPVB)复合全身麻醉对老年肺癌根治术患者的镇痛效果及对肾上腺皮质功能、认知功能的影响。
    方法 将70例老年肺癌根治术患者随机分为对照组(予以全身麻醉)和观察组(予以TPVB复合全身麻醉), 每组35例。观察并比较2组患者手术情况、心率(HR)、平均动脉压(MAP)、肾上腺皮质功能皮质醇(Cor)、促肾上腺皮质激素(ACTH)、醛固酮(ALD)和认知功能中枢神经特异性蛋白(S100β)、脑源性神经营养因子(BDNF)、简易智力状态检查量表(MMSE)评分。
    结果 观察组术中瑞芬太尼用量、术后患者自控静脉镇痛(PCIA)按压次数少于对照组，麻醉后监测治疗室(PACU)停留时间短于对照组，差异有统计学意义(P < 0.05)。手术开始5 min、术毕时，观察组HR、MAP均低于对照组，差异有统计学意义(P < 0.05)。术后24 h, 观察组Cor(319.03±44.41) μg/L、ACTH(12.05±1.64) pmol/L、ALD(119.00±20.68) ng/L, 分别低于对照组的(341.36±39.49) μg/L、(15.84±2.21) pmol/L、(186.88±22.03) ng/L, 差异有统计学意义(P < 0.05)。术后24 h, 观察组S100β水平为(96.94±15.51) ng/L, 低于对照组的(112.01±15.76) ng/L, 差异有统计学意义(P < 0.05); 术后24 h, 观察组BDNF水平、MMSE评分分别为(25.93±3.71) ng/mL、(25.34±1.63)分, 高于对照组的(23.43±4.60) ng/mL、(23.86±2.09)分，差异有统计学意义(P < 0.05)。
    结论 相较于全身麻醉, TPVB复合全身麻醉用于老年肺癌根治术患者可获得更好的镇痛效果，有利于术中血流动力学稳定与麻醉恢复，并可减轻对肾上腺皮质功能和认知功能的影响。

     

    Abstract:
    Objective To observe the analgesic effect of thoracic paravertebral block (TPVB) combined with general anesthesia in radical operation of elderly lung cancer, and its influence on adrenal cortex function and cognitive function.
    Methods Seventy elderly patients who underwent radical operation of lung cancer were randomly divided into control group (general anesthesia, n=35) and observation group (TPVB combined with general anesthesia, n=35). Operation conditions, heart rate (HR), mean arterial pressure (MAP), adrenocortical functions cortisol (Cor), adrenocorticotropic hormone (ACTH), aldosterone (ALD), and cognitive functions central nervous system specific protein (S100β), brain-derived neurotrophic factor (BDNF), and mini-mental state examination (MMSE) score were observed and compared.
    Results The intraoperative dosage of remifentanil and the compression times of patient-controlled intravenous analgesia (PCIA) were lower, and the length of post-anesthesia care unit (PACU) stay in the observation group was shorter than those in control group (P < 0.05). HR and MAP in the observation group were lower than those in the control group at 5 min of operation and at conclusion of operation, the differences were statistically significant (P < 0.05). At 24 h after surgery, the levels of Cor, ACTH and ALD were (319.03±44.41) μg/L, (12.05±1.64) pmol/L and (119.00±20.68) ng/L, respectively, which were lower than (341.36±39.49) μg/L, (15.84±2.21) pmol/L and (186.88±22.03) ng/L compared with the control group (P < 0.05). At 24 h after surgery, the level of S100β in the observation group was (96.94±15.51) ng/L, which was lower than (112.01±15.76) ng/L in the control group (P < 0.05). At 24 h after surgery, BDNF level and MMSE score in the observation group were (25.93±3.71) ng/mL and (25.34±1.63), respectively, which were higher than (23.43±4.60) ng/mL and (23.86±2.09) in the control group (P < 0.05).
    Conclusion TPVB combined with general anesthesia can achieve better analgesic effect in radical operation of elderly lung cancer. It is conducive to intraoperative hemodynamic stability and recovery from anesthesia, and can relieve the influence on adrenal cortex function and cognitive function.

     

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