前锯肌平面阻滞联合全身麻醉对老年胸腔镜肺腺癌根治术后患者认知功能的影响

Effects of serratus anterior muscle plane block combined with general anesthesia on cognitive function in elderly patients after thoracoscopic radical resection of lung adenocarcinoma

中文关键词: 老年, 肺腺癌, 肺腺癌根治术, 前锯肌, 全身麻醉, 神经阻滞, 认知障碍

英文关键词: elderly  lung adenocarcinoma  radical resection of lung adenocarcinoma  serratus anterior  general anesthe-sia  nerve block  cognitive dysfunction

中文摘要:

      目的 探究超声引导下前锯肌平面阻滞(SAPB)联合全身麻醉对老年患者胸腔镜肺腺癌根治术后早期认知功能和并发症的影响.方法 选取2023年1月-2023年12月南通市肿瘤医院择期行胸腔镜肺腺癌根治术老年患者60例,应用随机数字表法分为2组:复合组(n=30,采用超声引导下SAPB联合全身麻醉)和全麻组(n=30,采用气管插管全身麻醉).复合组于麻醉诱导前行超声引导SAPB,阻滞20 min后,用针刺法判断阻滞成功后,行气管插管全身麻醉.于术前1 d,术后第1、3、7天取静脉血样,测定血清S100β蛋白和神经特异性烯醇化酶(NSE)水平;于术后6、12、24、48 h记录2组患者疼痛评分;记录术中、术后阿片类镇痛药物用量和补救镇痛情况;应用简易精神状态量表(MMSE)于术前1 d,术后1、3、7 d评估患者认知功能,并记录术后认知功能障碍及其他并发症发生情况.结果 与全麻组相比,复合组VAS评分更低,术中瑞芬太尼、术后舒芬太尼用量更少,补救镇痛率更低;术后第1、3、7天的MMSE评分更高,7 d内认知功能障碍发生率更低;术后血清S100β蛋白和NSE水平更低;恶心呕吐发生率更低,差异均有统计学意义(P＜0.05).结论 超声引导下前锯肌平面阻滞联合全身麻醉可能对老年患者胸腔镜肺腺癌根治术后认知功能影响小,镇痛效果好,并发症发生率降低,有助于改善患者预后.

英文摘要:

      Objective To investigate the effects of ultrasound-guided serratus anterior muscle plane block(SAPB)combined with general anesthesia on early cognitive function and complications in elderly patients after thoracoscopic radical re-section of lung adenocarcinoma.Methods 60 elderly patients undergoing elective thoracoscopic radical surgery for lung ade-nocarcinoma in Cancer Hospital of Nantong City from January 2023 to December 2023 were selected and divided into two groups by random number table method:combined group(n=30,SAPB combined with general anesthesia under ultrasound guidance)and general anesthesia group(n=30,tracheal intubation general anesthesia).In the combined group,SAPB was guided under ultrasound before anesthesia induction and blocked for 20 min.After the successful block was judged by acupunc-ture,general anesthesia with tracheal intubation was performed.The venous blood samples were collected on day 1 before sur-gery and on days 1,3,and 7 after surgery to measure the concentrations of serum S100β protein and neurospecific enolase(NSE).The pain scores of both groups at 6,12,24,and 48 h after surgery were recorded.The intraoperative and postopera-tive opioid analgesic drug dosage and remedial analgesia in both groups were recorded.Patients'cognitive function was assessed with the Mini-Mental State Scale(MMSE)on 1 day before surgery and 1,3,and 7 days after surgery.The incidence of post-operative cognitive dysfunction and other complications were recorded and compared between the two groups.Results Com-pared with the general anesthesia group,the VAS score of the combined group was lower,the dosage of remifentanil during op-eration and sufentanil after operation was less,and the rate of remedial analgesia was lower;the MMSE scores on postoperative days 1,3,and 7 were higher,and the incidence of cognitive dysfunction within 7 days was lower;the concentrations of serum S100 β protein and NSE were lower after surgery;the incidence of nausea and vomiting was lower.The above differences be-tween the two groups were statistically significant(P＜0.05).Conclusion Ultrasound-guided SAPB combined with general anesthesia may have little effect on cognitive function in elderly patients after thoracoscopic radical resection of lung adenocarci-noma.It has good analgesic effect,can reduce incidence of complications,and is helpful to improve the prognosis of patients.