全麻复合椎旁神经阻滞对肺癌手术患者术后苏醒、炎症反应及认知功能的影响

Effect of General Anesthesia Combined with Thoracic Paravertebral Nerve Block on Postoperative Recovery, Inflammatory Response and Cognitive Function in Patients with Lung Cancer

【目的】探讨全麻复合胸椎旁神经阻滞(TPVB)对胸腔镜肺癌根治术患者术后苏醒、炎症反应、认知功能的影响。【方法】选取2014年4月至2019年4月于本院拟实施胸腔镜下肺癌根治术的80例患者作为研究对象,随机分为观察组和对照组各40例,观察组采取全麻复合TPVB麻醉、对照组采取全麻;比较两组患者的手术时间、单肺通气时间、手术出血量、苏醒时间、拔管时间、丙泊酚用量、瑞芬太尼用量、手术前后血清白细胞介素-6(1-6)、白细胞介素-10(IL10)、肿瘤坏死因子-α(TNF-α)、皮质醇(Cor)、脂联素(ADP).S1OO蛋白水平及术后认知功能障碍(PCOD)的发生率。【结果】两组手术时间、单肺通气时间、手术出血量比较.差异无统计学意义(P>0.05)。观察组患者苏醒时间长于对照组(P<0.05),拔管时间、丙泊酚用量、瑞芬太尼用量显著低于对照组(P<0.05)。术前,两组患者的血清IL-6、IL-10、TNF-α、Cor、ADP、S100蛋白水平比较,差异无统计学意义(P>0.05);术后24h,观察组血清IL-6、IL10、TNF-α、Cor、S100蛋白水平低于对照组(P<0.05),ADP水平高于对照组(P<0.05)。观察组的PCOD发生率显著低于对照组(P<0.05).【结论】全麻复合TPVB可延长胸腔镜肺癌根治术患者苏醒时间、减少拔管时间及麻醉药物用量、降低炎症反应及PCOD发生率。

[Objective] To investigate the effects of general an esthesia combined with thoracic paravertebral nerve block (TPVB) on postoperative recovery, inflammatory response and cognitive function in patients undergoing radical thoracoscopic lung cancer mastectomy.[Methods\A total of 80 patients with NSCLC who underwent thoracoscopic radical resection of lung cancer in our hospital from April 2014 to April 2019 were randomly assigned to the observation group and the control group according to the patient's admission time. The observation group received general anesthesia combined with TPVB while the control group underwent general anesthesia. The operation lime-single lung ventilation time, surgical bleeding volume, recovery time, extubation time, propofol dosage, remifentanil dosage, serum interleukin-6 (IL-6 ), interleukin-10 (IL-10 ), tumor necrosis factor-α(TNF-α), cortisol (Cor), adiponectin ( ADP), S100 protein and cog nitive dysfunction (PCOD) were compared between the two groups.[Results]There were no significant differences in the operation time, single lung ventilation time and surgical bleeding volume between the observation group and the control group ( P >0.05). The recovery time of the observation group was longer than that of the control group ( P <0.05). The extubation time, the dosage of propofol and remifentanil of the observation group were significantly lower than those of the control group ( P <0.05). There were no significant differences in serum levels of IL-6, IL-10, TNF-α Cor, A Dp and S100 protein between the two groups before surgery ( P > 0.05). At 24 hours after operation, the serum levels of IL-6 . IL-10, TNF-α. Cor and S100 protein in the observation group were lower than those in the control group ( P <0.05). While the ADP level the observation group was higher than in the control group ( P <0.05) at 24 hoours after surgery. PCOD incidence rate in the observation group was 10.00%, which was lower than that in the conirol group (31.11%),and the difference was statistically significant ( P <0.05).[Conclusion]General anesthesia combined with TPVB can prolong the recovery time, reduce the time of extubation and the amount of anesthetic drugs, reduce the inflammatory response and the incidence of PCOD in patients undergoing thoracoscopic radical resection of lung cancer.