星状神经节阻滞对行腹腔镜胃癌根治术老年患者术后认知功能的影响

Effect of Stellate Ganglion Block on Cognitive Function in ElderlyPatients Undergoing Laparoscopic Radical Gastrectomy

目的:分析星状神经节阻滞(SGB)对行腹腔镜胃癌根治术老年患者术后认知功能的影响。方法:选取我院2017年7月至2019年6月60例择期行腹腔镜胃癌根治术老年患者,随机分为研究组和对照组各30例。研究组于右侧第6颈椎横突部位注射1%利多卡因行SGB,对照组在相同部位给予注射0.9%NaCl溶液。记录两组患者术中心率、平均动脉压、术中出血量、术中输液量及手术时间等情况。通过简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估(MoCA)评估两组患者术前1d和术后1、3、7d认知功能。结果:两组患者术中出血量、术中输液量和手术时间的比较,提示差异均无统计学意义(P>0.05)。研究组在不同时间点时心率和平均动脉压更加平稳,而对照组不同时间点时心率和平均动脉压变化明显,差异具有统计学意义(P<0.05);两组患者术后1、3、7d时MMSE和MoCA评分较术前均明显减少(P<0.05)。研究组术后1、3、7d时MMSE和MoCA评分明显高于对照组(P<0.05)。研究组术后1d认知功能障碍发生率为13.33%(4/30),较对照组的43.33%(13/30)明显降低(P<0.05)。结论:SGB有利于改善腹腔镜胃癌根治术老年患者术后认知功能。

Objective:To analyze the effect of stellate ganglion block(SGB)on cognitive function in elderly patients undergoing laparoscopic radical gastrectomy.Methods:Sixty elderly patients undergoing laparoscopic radical gastrectomy in our hospital from July 2017 to June 2019 were randomly divided into study group and control group with 30 cases in each group.In the study group,1%lidocaine was injected into the right 6th cervical transverse process for SGB,while in the control group,0.9%NaCl solution was injected into the same part.The central rate,mean arterial pressure,intraoperative bleeding volume,intraoperative infusion volume and operation time of the two groups were recorded.The cognitive function of the two groups was assessed by Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)at 1 day before and 1,3 and 7 days after the operation.Results:There was no significant difference in intraoperative bleeding volume,intraoperative infusion volume and operation time between the two groups(P>0.05).The heart rate and mean arterial pressure in the study group were more stable at different time points,while the heart rate and mean arterial pressure in the control group were significantly different at different time points(P<0.05).The scores of MMSE and MoCA in the two groups were significantly lower than those before operation(P<0.05).The scores of MMSE and MoCA in the study group were significantly higher than those in the control group(P<0.05).The incidence of cognitive impairment in the study group was 13.33%(4/30)on the first day after operation,which was significantly lower than that in the control group which was 43.33%(13/30)(P<0.05).Conclusion:SGB can improve the cognitive function of elderly patients after laparoscopic radical gastrectomy.