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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

    摘要
  • 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(t0)、气管插管后即刻(t1)、手术开始时(t2)、手术开始后1 h(t3)、手术开始后2 h(t4)、术毕时(t5)、拔管后即刻(t6)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t0、t3、t4、t5时点血清电解质和血糖水平。分别于术前24 h(T0)、术后24 h(T1)、术后72 h(T2)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T0、T1、T2、术后5 d(T3)、术后7 d(T4)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t0、t1、t6时点，且SGB组t1、t2、t6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t4、t5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T1时点IL-6水平、T2时点IL-1水平和T1、T2时点S100β蛋白水平均低于对照组, T2时点IL-10水平高于对照组，差异有统计学意义(P < 0.05)。T1、T2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。

     

    Abstract:
    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 (t0), immediately after tracheal intubation (t1), at the beginning of surgery (t2), 1 h after surgery (t3), 2 h after surgery (t4), at the end of surgery (t5), immediately after extubation (t6), and at 30 min (t7) when entering the anesthesia recovery room (PACU) were observed. Changes of electrolytes and blood glucose were observed at t0, t3, t4 and t5. Plasma interleukin(IL)-1, IL-6, IL-10 and S100β concentrations were recorded at 24 h before (T0), 24 h after surgery (T1) and 72 h after surgery (T3). Cognitive function was assessed at T0, T1, T3, 5 d after operation (T4) and 7 d after operation (T5) using the Mini‐Mental State Examination(MMSE).
    Results HR at t7 in the SGB group was lower than that at t0, t1 and t6, and MAP and HR at t1, t2 and t6 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 t4 and t5 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 T1, IL-1 at T2 and S100β protein at T1 and T2 in the SGB group were lower than those in the control group, while the level of IL-10 at T2 was higher than those in control group (P < 0.05). At T1 and T2, the MMSE score of the SGB group was higher than that of the control group, and the incidence of POCD was lower than that of the control group (P < 0.05).
    Conclusion SGB improves postoperative cognitive function and decreases the incidence of POCD in elderly patients undergoing radical resection for gastrointestinal malignancy.

     

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