超声定位下颈丛神经阻滞联合帕瑞昔布钠对老年甲状腺癌切除术患者氧化应激、疼痛介质及术后认知功能的影响

Effects of Ultrasound Locatization of Cervical Plexus Block Combined with Parecoxib Sodium on Oxidative Stress,Pain Mediators and Postoperative Cognitive Function in Elderly Patients Undergoing Resection for Thyroid Cancer

目的探讨超声定位下颈丛神经阻滞联合帕瑞昔布钠对老年甲状腺癌切除术患者氧化应激、疼痛介质及术后认知功能障碍(POCD)的影响。方法选取2018年2月—2021年3月行老年甲状腺癌切除术112例,根据麻醉镇痛方法分为观察组和对照组各56例。对照组于麻醉诱导前予以超声定位下颈丛神经阻滞,观察组在对照组基础上联合帕瑞昔布钠。比较2组阻滞前(T0)、手术切皮时(T1)、切除甲状腺时(T2)、术毕时(T3)血流动力学指标,T0、术后12 h(T4)、术后24 h(T5)、术后48 h(T6)氧化应激指标及疼痛介质,观察T4、T5、T6疼痛情况及T0、T5、T6、术后7 d简易智能精神状态检查量表(MMSE)评分,并统计不良反应发生情况与术后7 d POCD发生率。结果观察组T1、T2、T3时心率、平均动脉压低于对照组(P<0.05);观察组T4、T5、T6时血清超氧化物歧化酶水平高于对照组,丙二醛、血清前列腺素E_(2)、P物质、神经肽Y水平及视觉模拟评分法评分低于对照组(P<0.05)。观察组T5、T6、术后7 d时MMSE评分高于对照组(P<0.05);观察组术后7 d POCD发生率低于对照组(P<0.05)。结论超声定位下颈丛神经阻滞联合帕瑞昔布钠能有效稳定老年甲状腺癌切除术患者术中血流动力学,减轻机体氧化应激及疼痛程度,减少术后POCD。

Objective To investigate effects of ultrasound locatization of cervical plexus block combined with Parecoxib Sodium on oxidative stress,pain mediators and postoperative cognitive dysfunction(POCD)in elderly patients undergoing resection for thyroid cancer.Methods A total of 112 elderly patients undergoing resection for thyroid cancer between February 2018 and March 2021 were selected and divided into observation group(n=56)and control group(n=56)according to different analgesic methods of anesthesia.Control group received ultrasound locatization of lower cervical plexus block before induction of anesthesia,while observation group was supplemented with Parecoxib Sodium on the basis of treatment for control group.Hemodynamic indexes before blocking(T0),at the time of surgical incision(T1),at the time of cutting thyroid gland(T2)and at the time of finishing surgery(T3)were compared between two groups.In two groups,oxidative stress indicators and pain mediator at T0,after surgery for 12 h(T4),after surgery for 24 h(T5)and after surgery for 48 h(T6)were compared;pain conditions at T4,T5 and T6,and simple intelligence State Examination Scale(MMSE)scores at T0,T5,T6,and after surgery for 7 d were observed,and incidence conditions of adverse reactions and the incidence rates of POCD after surgery for 7 d were calculated.Results Levels of heart rate(HR)and mean arterial pressure(MAP)at T1,T2 and T3 in observation group were significantly lower than those in control group(P<0.05).In observation group,levels of serum superoxide dismutase(SOD)were significantly higher,while levels of malondialdehyde(MDA),serum prostaglandin E_(2)(PGE_(2)),substance P(SP),neuropeptide Y(NPY)and visual analogue scale(VAS)scores were significantly lower than those in control group at T4,T5 and T6(P<0.05).At T5,T6 and after operation for 7 d,MMSE scores in observation group were significantly higher than those in control group(P<0.05).The incidence rate of POCD after operation for 7 d in observation group was significantly lower than that in control group(P<0.05).Conclusion Ultrasound locatization of cervical plexus block combined with Parecoxib Sodium may effectively stabilize the intraoperative hemodynamics,relieve oxidative stress and pain,and reduce incidence rate of postoperative POCD in elderly patients undergoing thyroid cancer resection.