腹横肌平面阻滞对老年患者腹部手术后认知功能及炎症反应的影响

Effect of transversus abdominis muscle block on cognitive function and inflammatory response in elderly patients after abdominal surgery

目的:研究超声引导下腹横肌平面阻滞对老年患者术后认知功能及炎症反应的影响。方法:选取2018年1月至2019年6月行腹腔镜下右半结肠癌手术患者92例,年龄60~75岁,ASA1-Ⅱ级,随机分为超声引导下腹横肌平面阻滞加全身麻醉组46例和全身麻醉组46例。阻滞加全麻组患者全身麻醉后,在超声引导下行双侧的腹横肌平面阻滞,全麻组患者全身麻醉;记录两组手术患者术前1 d、术后1 d、术后7 d的简易精神状态检查(Mini-mental state examination,MMSE);记录患者术前1 d、术后1 d、术后7 d检测血浆IL-1、IL-6、TNF-a炎性因子浓度的变化;记录患者入室后、麻醉开始后、手术切皮时、手术结束时各时间段有创动脉的平均动脉压(MAP)、心率(HR);记录患者术中使用舒芬太尼的总量、输注液体总量等。结果:阻滞加全麻组患者术中舒芬太尼使用总剂量低于全麻组(P<0.05);两组患者组内比较,术后1 d患者的MMSE评分均较术前1 d降低(P<0.05);阻滞加全麻组患者术后1 d检测IL-6血浆因子浓度较术前1 d降低(P<0.05)。结论:老年患者腹部手术时采用全身麻醉复合腹横肌平面阻滞后,可以降低舒芬太尼的使用剂量,也可以抑制患者术后1 d血浆中IL-6炎性因子的变化,同时未增加老年患者术后认知功能障碍的发生。

Objective:To study the effect of ultrasound-guided transverse abdominal muscle block on postoperative cognitive function and inflammatory reaction in elderly patients.Methods:92 patients,aged from 60 to 75 years old,ASA1-2,undergoing laparoscopic surgery for right colon cancer in our hospital from January 2018 to June 2019,were randomly divided into two groups:ultrasound-guided transverse abdominal muscle block plus general anesthesia group(group H,n=46)and general anesthesia group(group C,n=46).After general anesthesia,patients in group H received bilateral transverse abdominal muscle block under ultrasound guidance,and patients in group C received general anesthesia.The mini mental state examination(MMSE)was recorded in the two groups(1 day before operation,1 day after operation and 7 days after operation),and the changes of plasma levels of IL-1,IL-6 and TNF-a were recorded in patients(1 day before operation,1 day after operation and 7 days after operation).The mean arterial pressure((MAP)),heart rate((HR),),total amount of sufentanil and fluid infusion were recorded in patients(after entering the room,after the beginning of anesthesia,at the time of skin incision and at the end of operation).Results:There was significant difference in the total dose of sufentanil during operation between the two groups,and there was significant difference in MMSE between the two groups 1 day before operation and 1 day after operation(P<0.05).There was significant difference in the concentration of IL-6 plasma factors between the two groups 1 day before operation and 1 day after operation(P<0.05).Conclusion:General anesthesia combined with transverse abdominal muscle block in elderly patients during abdominal surgery can not only reduce the total dose of sufentanil,but also inhibit the changes of IL--6 inflammatory factors in plasma 1 day after operation.It does not increase the incidence of postoperative cognitive impairment in elderly patients.