摘要
目的探讨超声引导下腰方肌阻滞(QLB)联合静脉全身麻醉对老年患者腹腔镜胃癌根治术围术期神经认知功能紊乱(PND)的影响。方法选取2019年1月至2020年12月丽水市中心医院实施腹腔镜胃癌根治术的老年患者80例,按随机数字表法分为QLB联合静脉全身麻醉(观察组)和单纯静脉全身麻醉(对照组),每组40例。比较两组患者术中镇痛效果、麻醉药用量、术后PND发生率以及气管插管前15 min(T_(1))、术后24 h(T_(2))、术后72 h(T_(3))的简易智能状态(MMSE)评分、疼痛数字评分(NRS)、布鲁格曼舒适度(BCS)、血清血管内皮生长因子(VEGF)水平的差异并作分析。结果两组患者术中镇痛效果相似,但观察组丙泊酚、瑞芬太尼用量均明显低于对照组(均P<0.01)。观察组PND发生率为5.0%,显著低于对照组的30.0%(P<0.05)。与对照组比较,观察组患者T_(2)、T_(3)时NRS评分显著降低(均P<0.01),BCS评分明显增高(均P<0.01);T_(2)时MMSE评分及血清VEGF水平明显降低(均P<0.05),但T_(1)、T_(3)时差异均无统计学意义(均P>0.05)。结论超声引导下QLB联合静脉全身麻醉能减少腹腔镜下胃癌根治术老年患者麻醉药物用量和PND发生率,提高患者的舒适度,是一种有效的治疗方案。
Objective To investigate the effects of quadratus lumborum block(QLB)on perioperative neurocognitive disorders(PND)in elderly patients with gastric cancer undergoing laparoscopic radical gastrectomy.Methods Eighty patients aged≥65 years undergoing laparoscopic radical gastrectomy for gastric cancer in Lishui Municipal Central Hospital from January 2019 to December 2020 were randomly divided into study group and control group.Patients in study group received QLB combined with intravenous general anesthesia,while patients in control group received intravenous general anesthesia alone.The anesthesia effects,dosage of anesthesia agents and incidence of PND between the two groups were compared.The cognitive state of patients was evaluated with mini-mental state examination(MMSE),the pain score was evaluated with numerical rating scale(NRS),comfort level was evaluated with Bruggrmann comfort scale(BCS),and the serum levels of vascular endothelial growth factors(VEGF)were measured at 15 min pre-endotracheal intubation(T_(1)),24 h after surgery(T_(2))and 72 h after surgery(T_(3)).Results The anesthesia effects of the two groups were comparable,but the total dosage of propofol and remifentanil in the study group was significantly lower than that in control group(P<0.01).The incidence of PND in the study group was significantly lower than that in the control group(5.0%vs.30.0%,P<0.05).Compared with the control group,the NRS scores at T_(2)and T_(3)in the study group were significantly lower(P<0.01),the BCS scores were significantly higher(P<0.01).The MMSE scores(P<0.01)and VEGF values decreased significantly at T_(2)(P<0.05),but did not decrease at T_(1)and T_(3).Conclusion Ultrasound-guided QLB combined with intravenous general anesthesia can reduce the dosage of anesthetic drug,incidence of PND and improve the comfort level of elderly patients with gastric cancer undergoing laparoscopic radical gastrectomy.
作者
王传光
周建伟
尧银光
羊丽丽
WANG Chuanguang;ZHOU Jianwei;YAO Yinguang;YANG Lili(Department of Anesthesiology,Lishui Municipal Central Hospital,Lishui 323000,China)
出处
《浙江医学》
CAS
2022年第1期55-59,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2021KY413)
丽水市高层次人才培养资助项目(2019RC03)。
关键词
腰方肌阻滞
静脉全身麻醉
围术期神经认知功能紊乱
老年患者
胃癌根治术
Quadratus lumborum block
Intravenous general anesthesia
Elderly patients
Radical gastrectomy
Perioperative neurocognitive disorders
