老年胸外科手术患者应用肋间神经阻滞术后早期认知功能障碍及术后镇痛情况观察

A observation of early postoperative cognitive dysfunction and postoperative analgesia situation after intercostal nerve block was applied on elderly patient received thoracic surgery

目的:探讨老年胸外科手术患者应用肋间神经阻滞术后早期认知功能障碍及术后镇痛情况。方法:选择在医院择期手术的105例老年胸外科手术患者,按随机数表法将患者分为观察组、对照A组和对照B组,每组35例;观察组采用肋间神经阻滞联合全身麻醉,对照A组采用硬膜外麻醉联合全身麻醉,对照B组采用常规全身麻醉,比较3组患者的认知功能、术后疼痛情况和术中患者的平均动脉压(MAP)及心率(HR)。结果:观察组患者术后12 h、24 h及72 h的认知功能评分高于对照A组,差异具有统计学意义(t=20.917,t=27.780,t=74.081;P<0.05),同时高于对照B组,差异具有统计学意义(t=37.922,t=48.969,t=62.653;P<0.05)。观察组患者术中的MAP、HR值与对照A组患者比较差异具有统计学意义(t=18.927,t=22.380;P<0.05);与对照B组患者比较差异具有统计学意义(t=31.051,t=19.932;P<0.05)。观察组与对照A组患者的术后6 h,12 h,24 h和48 h疼痛评分差异无统计学意义,但均明显低于对照B组,差异具有统计学意义(t=18.731,t=19.035,t=21.093,t=17.036;P<0.05)。结论:老年胸外科手术患者应用肋间神经阻滞联合全身麻醉可使患者的术中生命体征更加平稳,有助于改善早期认知功能,并具有较好的术后镇痛效果。

Objective:To investigate the effect of early postoperative cognitive dysfunction and postoperative analgesia situation after intercostal nerve block was applied on elderly patient received thoracic surgery.Methods:105elderly patients underwent thoracic surgeries were divided into observation group(35patients received intercostal nerve block combined with general anesthesia),control A group(35patients received epidural anesthesia combined with general anesthesia)and control B group(35patients received routine general anesthesia).The cognitive function,postoperative pain,intraoperative mean artery pressure(MAP)and heart rate of the patients among different groups were respectively compared.Results:The cognitive function scores in postoperative12h,24h,72h of observation group were significantly higher than that of control A group(t=20.917,t=27.780,t=74.081,P<0.05),respectively.And all of these data also were significantly higher than that of control B group(t=37.922,t=48.969,t=62.653,P<0.05),respectively.The differences of MAP,HR value between observation group and control A group were statistically significant(t=18.927,t=22.380,P<0.05),respectively.And the differencesof them between observation group and control B group also were statistically significant(t=31.051,t=19.932,P<0.05),respectively.Besides,the differences of pain scores in postoperative6h,12h,24h,48h between observation group and control A group were not statistically significant,while all of pain scores of observation group were significantly lower than that of control B group(t=18.731,t=19.035,t=21.093,t=17.036;P<0.05).Conclusion:Intercostal nerve block combined with general anesthesia can ensure more stable intraoperative vital signs for elderly patients underwent thoracic surgeries,and it contributes to improve early cognitive function and possesses better postoperative analgesic effect for elderly patients.