胸椎旁神经阻滞保留自主呼吸麻醉对老年胸腔镜手术患者术中脑氧合和术后谵妄的影响

Effects of thoracic paravertebral nerve block combined with preserved spontaneous respiratory anesthesia on intraoperative cerebral oxygenation and postoperative delirium in elderly patients undergoing thoracoscopic surgery

目的观察胸椎旁神经阻滞(TPVB)保留自主呼吸麻醉对老年胸腔镜手术患者术中局部脑氧饱和度(S_(rc)O_(2))和术后谵妄(POD)的影响。方法将80例拟择期行胸腔镜下肺楔形切除术的老年患者随机分成对照组和观察组,最终76例患者完成研究,其中对照组39例,观察组37例。对照组采用单肺通气下全身麻醉,观察组采用TPVB保留自主呼吸麻醉。通过近红外光谱仪监测患者S_(rc)O_(2),以S_(rc)O_(2)较基线下降≥10%为脑局部氧合不足(COD)。比较2组术前S_(rc)O_(2)基线值,术中S_(rc)O_(2)最低值,COD发生率及其持续时间;统计手术情况及术中低血压、低血氧、苏醒延迟发生率、镇痛补救率;评估术后2 h、24 h和72 h的POD发生率和疼痛视觉模拟量表(VAS)评分;记录住院时间,并评估入院和出院时的40项恢复质量评分量表(QoR-40)评分。结果2组患者手术时间、术中出血量、术前S_(rc)O_(2)基线值、术后2 h的VAS评分和入院时的QoR-40评分比较差异无统计学意义(P>0.05)。与对照组比较,观察组术中S_(rc)O_(2)最低值更高(P<0.05),COD发生率更低、持续时间更短(P<0.05),术后2 h、24 h、72 h的POD发生率更低(P<0.05),术后24 h、72 h的VAS评分以及镇痛补救率更低(P<0.05),术中低血压发生率、苏醒延迟发生率和住院时间均更低/短(P<0.05),且出院时的QoR-40评分更高(P<0.05)。结论TPVB保留自主呼吸麻醉可改善老年胸腔镜手术患者术中脑氧合水平,减少POD的发生。

Objective To observe the effects of thoracic paravertebral nerve block(TPVB)combined with preserved spontaneous respiratory anesthesia on intraoperative local cerebral oxygen saturation(S_(rc)O_(2))and postoperative delirium(POD)in elderly patients undergoing thoracoscopic surgery.Methods A total of 80 elderly patients who planned to undergo thoracoscopic wedge resection of lung were randomly divided into the control group and the observation group,and finally 76 patients completed the study,with 39 cases in the control group and 37 cases in the observation group.The control group was given general anesthesia under single lung ventilation,while the observation group was given TPVB combined with preserved spontaneous respiratory anesthesia.Patients'S_(rc)O_(2) was monitored by a near infrared spectrometer,and the decrease of S_(rc)O_(2) from baseline by≥10%was considered as cerebral oxygen desaturation(COD).The preoperative baseline value of S_(rc)O_(2),intraoperative lowest value of S_(rc)O_(2),the incidence and duration of COD of the two groups were compared.The operation situation,the incidence of hypotension,hypoxemia,delayed awakening and analgesic recovery rate were counted.The incidence of POD and pain visual analogue scale(VAS)score 2 hours,24 hours and 72 hours after surgery were evaluated.The hospitalization time was recorded,and the quality of recovery-40(QoR-40)scores at admission and discharge were evaluated.Results There was no significant difference in operative time,intraoperative blood loss,preoperative baseline value of S_(rc)O_(2),VAS score 2 hours after surgery and QoR-40 score at admission between the two groups(P>0.05).Compared with the control group,the observation group had higher intraoperative lowest value of S_(rc)O_(2)(P<0.05),lower incidence and shorter duration of COD(P<0.05),lower incidence of POD 2 hours,24 hours and 72 hours after surgery(P<0.05),lower VAS scores 24 hours and 72 hours after surgery and analgesic recovery rate(P<0.05),lower/shorter incidence of intraoperative hypotension,delayed awakening and hospitalization time(P<0.05),and higher QoR-40 scores at discharge(P<0.05).Conclusion TPVB combined with preserved spontaneous respiratory anesthesia can improve the level of cerebral oxygenation and reduce the occurrence of POD in elderly patients undergoing thoracoscopic surgery.