全麻联合胸椎旁阻滞对食管癌手术患者苏醒期躁动及术后认知功能障碍的影响

Effect of General Anesthesia Combined Thoracic Paravertebral Block on Emergence Agitation and Postoperative Cognitive Dysfunction in Patients with Esophageal Cancer Surgery

目的探讨全麻联合单侧胸椎旁阻滞对老年食管癌根治术患者苏醒期躁动和认知功能障碍的影响。方法 60例择期行食管癌根治术老年患者,随机分两组,A组为单纯全麻,B组采用全麻复合单侧胸椎旁阻滞。观察两组入室时(T0)、插管后5 min(T1)、手术开始后10 min(T2)、单肺通气开始1 h(T3)、单肺通气结束10 min(T4)、手术结束时(T5)、拔管前(T6)、拔管时(T7)、拔管后5 min(T8)MAP、HR的变化,记录术中瑞芬太尼、七氟烷用量,苏醒时间、拔管时间以及拔管前镇静躁动评分、拔管后5 min Ramsay镇静评分、拔管后10 min VAS评分。于术前1 d和术后第7 d对患者认知功能进行评估。结果与A组比,B组术中瑞芬太尼、七氟烷用量减少;B组T5~T8时的MAP明显低于A组,T6-T8时的HR明显慢于A组;B组苏醒时间、拔管时间明显短于A组;拔管前镇静躁动评分、拔管后10 min VAS评分,B组明显低于A组,拔管后Ramsay镇静评分两组对比无统计学差异;B组在术后第7 d认知功能障碍发生率明显低于A组。结论全麻联合单侧胸椎旁阻滞能够较好的抑制食管癌根治术患者术中的应激反应,并明显改善术后恢复质量与认知功能损伤,值得推广。

Objective To evaluate the effect of general anesthesia combined thoracic paravertebral block on emergence agitation and postoperative cognitive disfunction in the patients undergoing radical surgery for esophageal carcinoma. Methods 60 elderly pa- tients with scheduled for radical resection of esophageal cancer were randomly divided into 2 groups： the general anesthesia group （group A） and the general anesthesia combined thoracic paravertebral block group （group B）. Changes of MAP, HR were recorded in the moment of going operating room （T0）, 5 mins after trachea cannula（ T1 ）, 10 mins After surgery （T2）, 1 hour after one-lung ventilation （T3）, 10 mins after one-lung ventilation finish （T4）, the moment of surgery finish（ T5 ）, before extubation（ T6 ）, the moment of extubation（ T7 ）, and 5 mins after extubation（ T8 ）. The dosage of remifentanil and sevoflurane, recovery time, the recov- ery time, extubation time, riker sedation-agitation score before extubation and ramsay sedation score 5 min after extubation were ob- served. The cognitive function were evaluated 1 day before operation and after 7th day after operation. Results The dosages of remifentanil and sevoflurane were significantly decreased in group B compared with those in group A. MAP at T5 -T8 and HR at T6- T8 in group B were significantly lower than those in group A. The recovery time, extubation time in group B were significantly shorter than those in group A. Riker sedation-agitation scores before extubation and VAS scores 10 mins after extubation in group B were sig- nificantly lower than those in group A. There was no difference between the two groups in ramsay scores after extubation. The inci- dence of agitation in group B were significantly lower than those in group A in 7th day after operation. Conclusion General anesthe- sia combined thoracic paravertebral block can effectively inhibit the stress response in patients with esophageal cancer radical surgery, and significantly improve postoperative recovery quality and cognitive disfunction. So it is worth promoting.