右美托咪定复合椎旁神经阻滞麻醉对先天性脊柱侧弯患儿围术期及术后认知功能的影响

Effect of dexmedetomidine combined with paravertebral nerve block anesthesia on perioperative and postoperative cognitive function in children with congenital scoliosis

目的探讨右美托咪定复合椎旁神经阻滞麻醉对先天性脊柱侧弯患儿围术期及术后认知功能的影响。方法选取该院2014年3月至2019年2月接受先天性脊柱侧弯矫形术患儿90例,采用随机数表法分为观察组(n=45)和对照组(n=45)。对照组采用椎旁神经阻滞后进行全身麻醉,观察组采用右美托咪定复合椎旁神经阻滞后进行全身麻醉。在注入右美托咪定前(T 0)、术后24 h(T 1)、术后48 h(T 2),观察两组患儿心率(HR)、平均动脉压(MAP)等生命体征,检测白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及中枢神经特异性蛋白(s100β蛋白)水平,测评应激反应和认知功能情况。结果两组患儿在T 0时刻比较,HR、MAP差异均无统计学意义(P>0.05);在T 1时刻观察组HR、MAP低于对照组(P<0.05);T 2时刻HR低于对照组,相比T 1时刻,HR逐渐趋于平衡状态,MAP低于对照组,相比T 1时刻MAP缓慢回升,两组相比较差异均具有统计学意义(P<0.05)。观察组与对照组血清IL-6、TNF-α及s100β蛋白水平在T 0时刻比较,差异无统计学意义(P>0.05),观察组在T 1、T 2时刻炎性因子血清IL-6、TNF-α及s100β水平低于对照组,差异具有统计学意义(P<0.05);T 1、T 2时刻比较,s100β蛋白、血清IL-6、TNF-α水平逐渐减低,但差异无统计学意义(P>0.05)。T 0时两组患儿简易智力状态检查(MMSE)评分差异无统计学意义(P>0.05);T 1时评分显著降低,但观察组评分优于对照组(P<0.05);T 2时两组患儿评分均有所上升且观察组优于对照组(P<0.05)。两组患儿T 1、T 2时观察组镇静评分高于对照组且达到满意镇静效果(P<0.05);躁动评分对比,观察组低于对照组(P<0.05)。结论右美托咪定复合椎旁神经阻滞麻醉能减少患儿术后认知功能障碍发生率,减轻围术期炎性反应及应激反应,稳定血流动力学,在先天性脊柱侧弯患儿围术期内值得推广。

Objective To investigate the effect of dexmedetomidine combined with paravertebral nerve block anesthesia on perioperative and postoperative cognitive function in children with congenital scoliosis.Methods Ninety cases of congenital children who underwent scoliosis orthopedic surgery from March 2014 to March 2019 were enrolled in our hospital.The patients were divided into observation group(n=45)and control group(n=45)by random number table method.The control group underwent general anesthesia with paravertebral nerve block lag,and the observation group underwent general anesthesia with dexmedetomidine combined with paravertebral nerve block.Heart rate HR(Heart Rate)and Mean Artery Pressure(Mean Artery Pressure)vital signs were observed before injection of dexmedetomidine hydrochloride(T 0),postoperative 24h(T 1),and postoperative 48h(T 2).Interleukin-6(IL-6),Tumor Necrosis Factor-α(TNF-α)and s100βprotein levels,stress response and cognitive function.Results There was no significant difference in HR and MAP between the two groups at T0(P>0.05).The HR,MAP were both lower than the control group(P<0.05).HR was lower than the control group at T 2.Compared with T1,HR gradually became equilibrium,MAP was lower than that of the control group,and MAP was slowly increased compared with T 1.The difference between the two groups was statistically significant(P<0.05).The levels of serum IL-6,TNF-αand s100βprotein in the observation group and the control group were compared at T 0,the difference was not statistically significant(P>0.05),and the inflammatory factor serum of the observation group at T 1 and T2 was observed.The concentrations of IL-6,TNF-αand the s100βprotein level were significantly lower than those of the control group,the difference was statistically significant(P<0.05).Comparison of T 1 and T 2 the levels of s100βprotein,serum IL-6 and TNF-αwere gradually decreased,but the difference was not statistically significant(P>0.05).The MMSE of children in two groups at T 0 There was no significant difference in MMSE scores(P>0.05);The score was significantly lower at T 1,but the score of the observation group was superior to that of the control group(P<0.05);At the time of T 2,the scores of the two groups were observed,and the scores were all increased and the observation group was superior to the control group(P<0.05).The sedation scores of the observation group were significantly higher than those of the control group and satisfied with T 1 and T 2.The sedative effect(P<0.05)and the agitation score were significantly lower in the observation group than in the control group(P<0.05).Conclusion Dexmedetomidine combined with paravertebral nerve block anesthesia can reduce the incidence of postoperative cognitive dysfunction,perioperative inflammatory response,stress response,and stabilize hemodynamics.It is worth promoting in the perioperative period of children with congenital scoliosis.