星状神经节阻滞对老年心脏手术患者术后近期认知功能的影响

The effection of stellate ganglion block on short-term cognitive function in elderly patients undergoing cardiac surgery

目的探讨星状神经节阻滞对老年患者心脏手术术后近期认知功能的影响。方法选择美国麻醉医师协会(ASA)评分Ⅰ～Ⅲ级、行心脏手术的老年患者24例,根据计算机随机数字分为试验组和对照组。通过蒙特利尔认知功能评分量表(MoCA)及简易精神状态量表(MMSE)评价老年患者术后认知功能障碍(POCD)发生率,记录患者术间体外循环(CPB)时间、升主动脉阻闭时间、心肌停搏液灌注量、灌注次数、重症监护病房(ICU)停留时间。结果术中2组术间CPB时间、升主动脉阻闭时间、心肌停搏液灌注量及灌注次数等参数差异无统计学意义(P>0.05),试验组在ICU停留时间低于对照组。试验组MoCA评分及MMSE评分均较对照组低(P<0.05),其中试验组空间执行功能、言语流畅性、记忆力评分低于对照组(P<0.01),计算力、命名、注意力、定向力、抽象能力差异无统计学意义(P>0.05)。结论星状神经阻滞可有效降低老年患者心脏手术POCD的发病率,促进患者早期康复,提高患者术后满意度。

Objective To investigate the effect of stellate ganglion block on cognitive function in elderly patients after cardiac surgery. Methods Twenty-four elderly patients with ASA grade Ⅰ-Ⅲ undergoing cardiac surgery were randomly divided into experimental group and control group. The incidence of postoperative cognitive impairment (POCD) was evaluated by MoCA score and MMSE score. CPB time, ascending aorta occlusion time, myocardial cardioplegia perfusion volume, perfusion times and ICU stay time were recorded. Results There was no significant difference in CPB time, ascending aorta occlusion time, myocardial cardioplegia perfusion volume and perfusion times between the two groups (P>0.05). The duration of ICU stay in the experimental group was lower than that in the control group. The scores of MoCA and MMSE in the experimental group were lower than those in the control group (P< 0.05). The scores of spatial executive function, speech fluency and memory in the experimental group were lower than those in the control group (P<0.01). There was no significant difference in the ability of calculation, naming, attention, orientation and abstraction (P>0.05). Conclusion Stellate nerve block can effectively reduce the incidence of POCD in elderly patients after cardiac surgery, promote early rehabilitation and improve the satisfaction of patients after cardiac surgery.