胸横肌平面阻滞对体外循环下瓣膜置换患者术后认知功能障碍发生的影响

Effect of transversus thoracic muscle plane block on perioperative neurocognitive disorders in patients with valve replacement under cardiopulmonary bypass

目的探讨胸横肌平面阻滞对体外循环(CPB)下瓣膜置换患者围手术期神经认知障碍(PND)发生的影响。方法选取择期在CPB下行瓣膜置换术的患者156例,随机将其分为A、B两组,各78例。B组为全麻组,行全身麻醉;A组为阻滞全麻组,即先行胸横肌平面阻滞,后行全身麻醉。比较两组术中舒芬太尼用量和术后24 h镇痛泵按压情况;比较两组术后(6、12与24)h静息和咳嗽时VAS评分;比较两组麻醉前(T_(1))、术毕(T_(2))、术后6 h(T_(3))及术后24 h(T_(4))血清TNF-α、IL-6、NSE与S-100β;比较两组术前1 d及术后(1、3与7)d简易智能状态检查量表(MMSE)评分;比较两组术后(1、3与7)d PND发生率。结果A组术中舒芬太尼用量和术后24 h镇痛泵按压次数少于B组(P<0.05);术后(6、12、与24)h,A组静息和咳嗽时VAS评分低于B组(P<0.05);在T_(2)、T_(3)与T_(4)时,A组血清TNF-α与IL-6水平低于B组(P<0.05);A组血清NSE与S-100β低于B组(P<0.05);术后(1、3和7)d,B组MMSE评分高于A组(P<0.05);术后(1、3与7)d,A组PND发生率低于B组(P<0.05)。结论胸横肌平面阻滞用于CPB下瓣膜置换患者能有效抑制炎性细胞因子释放,减轻神经损伤,改善术后认知功能,从而减少PND发生。

AIM To explore the effect of transversus thoracic muscle plane block on perioperative neurocognitive disorders(PND)in patients with valve replacement under cardiopulmonary bypass(CPB).METHODS One hundred and fifty-six patients with valve replacement under CPB were selected and randomly divided into group A and group B,78 cases in each group.The patients in group A received general anesthesia and the patients in group B received transversus thoracic muscle plane block before general anesthesia.The total amount of sufentanil in the operation and the pressing times of analgesic pump within 24 hours after operation were compared between the two groups.The VAS scores at rest and at cough at 6h,12h and 24h after operation were compared between the two groups.Serum TNF-α,IL-6,NSE and S-100βwere compared between the two groups before anesthesia(T_(1)),at the end of operation(T_(2)),6 hours after operation(T_(3))and 24 hours after operation(T_(4)).The scores of Mini Mental State Examination(MMSE)were compared between the two groups at 1d day before operation and at 1d,3 d and 7d after operation.The incidence of PND at 1d,3d and 7d after operation was compared between the two groups.RESULTS The total amount of sufentanil in the operation and the pressing times of analgesic pump within 24 hours after operation in group A were less than those in group B(P<0.05).The VAS scores at rest and at cough in group A were lower than those in group B at 6h,12h and 24h after operation(P<0.05).At T_(2),T_(3) and T_(4),the serum levels of TNF-αand IL-6 in group A were lower than those in group B(P<0.05).The serum levels of NSE and S-100βin group A were lower than those in group B(P<0.05).The MMSE scores in group A were higher than those in group B at 1,3 and 7 days after operation(P<0.05).The incidence of PND in group A was lower than that in group B at 1d,3d and 7d days after operation(P<0.05).CONCLUSION Transversus thoracic muscle plane block effectively inhibits the release of inflammatory cytokines,reduces nerve injury and improves postoperative cognitive function,thus reducing the occurrence of PND for patients with valve replacement under CPB.