超声引导下腰方肌外侧路阻滞联合少阿片类药物麻醉对老年腹腔镜肾癌根治术患者的影响

Effect of quadratus lumborum block combined with less opioid anesthesia under ultrasound guidance on elderly patients with laparoscopic radical nephrectomy

目的分析超声引导下腰方肌外侧路阻滞联合少阿片类药物麻醉对老年腹腔镜肾癌根治术患者神经损伤因子、疼痛程度及精神状态的影响。方法选取2021年8月—2022年8月于河北北方学院附属第一医院接受腹腔镜肾癌根治术治疗的60例老年患者,采用简单随机化法分为对照组和研究组,每组30例。所有患者接受超声引导下腰方肌外侧路阻滞。对照组联合传统阿片类药物麻醉,研究组联合少量阿片类药物麻醉。记录两组静态与动态视觉模拟评分(VAS)、镇痛泵按压次数与术后恢复指标;比较不同时间点[麻醉诱导前(T0)、术后1 d(T_(1))、术后3 d(T_(2))与术后7 d(T_(3))]的简易精神状态检查量表(MMSE)及神经损伤因子5-羟色胺(5-HT)、脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)水平。结果研究组首次排气时间、首次排便时间、下床活动时间均短于对照组(P<0.05),镇痛泵按压次数低于对照组(P<0.05);两组术后12、24和48 h的静息VAS评分、活动VAS评分相比,差异无统计学意义(P>0.05);研究组T_(1)、T_(2)、T_(3)时的MMSE评分与BDNF水平均高于对照组,血清5-HT、NSE水平低于对照组(P<0.05);研究组麻醉相关不良反应发生率低于对照组(P<0.05)。结论超声引导下腰方肌外侧路阻滞联合少阿片类药物麻醉应用于老年腹腔镜肾癌根治术中可减轻患者围手术期的疼痛程度,缩短术后恢复时间,改善认知功能与神经损伤因子表达。

Objective To analyze the impact of ultrasound-guided lumbar plexus lateral block combined with minimal opioid anesthesia on neuroinjury factors,pain levels,and mental status in elderly patients undergoing laparoscopic radical nephrectomy for renal cancer.Methods Sixty elderly patients undergoing laparoscopic radical nephrectomy from August 2021 to August 2022 at the First Affiliated Hospital of North University of China were selected.They were randomly divided into a control group and a study group,with 30 patients in each group.All patients received ultrasound-guided lumbar plexus lateral block.The control group received combined traditional opioid anesthesia,while the study group received combined minimal opioid anesthesia.Static and dynamic Visual Analog Scale(VAS)scores,patient-controlled analgesia(PCA)pump presses,and postoperative recovery indicators were recorded.The Mini-Mental State Examination(MMSE)and the levels of neuroinjury factors serotonin(5-HT),brain-derived neurotrophic factor(BDNF),and neuron-specific enolase(NSE)were compared at different time points[anesthesia induction(T0),postoperative day 1(T_(1)),postoperative day 3(T_(2)),and postoperative day 7(T_(3))].Results The study group had significantly shorter first-time gas evacuation,first-time defecation,and time to get out of bed compared to the control group(P<0.05).The number of PCA pump presses was lower in the study group than in the control group(P<0.05).There was no significant difference in resting VAS scores and activity VAS scores between the two groups at 12,24,and 48 hours postoperatively(P>0.05).MMSE scores and BDNF levels in the study group at T_(1),T_(2),and T_(3)were higher than those in the control group,while serum 5-HT and NSE levels were lower than those in the control group(P<0.05).The incidence of anesthesia-related adverse reactions in the study group was lower than that in the control group(P<0.05).Conclusion:Ultrasound-guided lumbar plexus lateral block combined with minimal opioid anesthesia in elderly patients undergoing laparoscopic radical nephrectomy for renal cancer can alleviate perioperative pain,shorten postoperative recovery time,and improve cognitive function and the expression of neuroinjury factors.